Challenges and opportunities for educating health professionals after the COVID-19 pandemic.

The education of health professionals substantially changed before, during, and after the COVID-19 pandemic. A 2010 Lancet Commission examined the 100-year history of health-professional education, beginning with the 1910 Flexner report. Since the publication of the Lancet Commission, several transformative developments have happened, including in competency-based education, interprofessional education, and the large-scale application of information technology to education. Although the COVID-19 pandemic did not initiate these developments, it increased their implementation, and they are likely to have a long-term effect on health-professional education. They converge with other societal changes, such as globalisation of health care and increasing concerns of health disparities across the world, that were exacerbated by the pandemic. In this Health Policy, we list institutional and instructional reforms to assess what has happened to health-professional education since the publication of the Lancet Commission and how the COVID-19 pandemic altered the education process.

Early and intensive Motor Training for people with spinal cord injuries (the SCI-MT Trial): description of the intervention.

STUDY DESIGN: Descriptive. OBJECTIVES: The primary objective is to describe the intervention that will be provided in a large multi-centre randomised controlled trial titled: Early and Intensive Motor Training for people with Spinal Cord Injuries (the SCI-MT Trial). The secondary objective is to describe the strategies that will be used to operationalise and standardise the Motor Training provided to participants while keeping the intervention person-centred. METHODS: The paper focuses on the rationale and principles of Motor Training for people with spinal cord injuries (SCI). The description of the intervention is based on the Template for Intervention Description and Replication (TIDieR) checklist. Specifically, it addresses the following 6 criteria of the TIDieR checklist: why the effectiveness of Motor Training is being examined; what, how, where and when the Motor Training will be administered; and how much Motor Training will be provided. RESULTS: A detailed intervention manual has been developed to help standardise the delivery of the intervention. CONCLUSIONS: This paper describes the details of a complex intervention administered as part of a large randomised controlled trial. It will facilitate the subsequent interpretation of the trial results and enable the intervention to be reproduced in clinical practice and future trials.

Evaluating factors associated with the cancellation and delay of elective surgical procedures: a systematic review.

BACKGROUND: Elective surgery cancellation is considered a fundamental problem in health care services-it causes considerable disruption to patient flow, further eroding often already stretched operating capacity, and consequentially reduces both hospital performance and patient satisfaction. This research presents a systematic review (SR) of the reasons for surgery cancellation among different hospitals and countries. By highlighting these causes, we identify how to reduce cancellations, thereby improving the use of surgical capacity and resources and creating a more predicable patient flow. METHODS: An SR was performed on elective surgery cancellation in compliance with the Preferred Reporting Items for Systematic Review and Meta-Analysis and by assessing the methodological quality of SR with Measurement Tool to Assess Systematic Reviews guidelines. RESULTS: There are different reasons for surgery cancellation that vary between hospitals. This SR demonstrates that hospital-related causes (e.g. unavailable operation room time, inappropriate scheduling policy and lack of beds) are the primary reason for surgery cancellation, followed by work-up related causes (e.g. medically unfit and changes in the treatment plan) and patient-related causes (e.g. absence of a patient and patient refusal). CONCLUSION: This review demonstrates that the main causes for surgery cancellation can be controlled by hospital managers, who can aim to improve areas such as patient flow and capacity management. Ultimately, this will improve the quality of healthcare delivered by hospitals.

Coordinated Plasticity of Synapses and Astrocytes Underlies Practice-Driven Functional Vicariation in Peri-Infarct Motor Cortex.

Motor rehabilitative training after stroke can improve motor function and promote topographical reorganization of remaining motor cortical movement representations, but this reorganization follows behavioral improvements. A more detailed understanding of the neural bases of rehabilitation efficacy is needed to inform therapeutic efforts to improve it. Using a rat model of upper extremity impairments after ischemic stroke, we examined effects of motor rehabilitative training at the ultrastructural level in peri-infarct motor cortex. Extensive training in a skilled reaching task promoted improved performance and recovery of more normal movements. This was linked with greater axodendritic synapse density and ultrastructural characteristics of enhanced synaptic efficacy that were coordinated with changes in perisynaptic astrocytic processes in the border region between head and forelimb areas of peri-infarct motor cortex. Disrupting synapses and motor maps by infusions of anisomycin (ANI) into anatomically reorganized motor, but not posterior parietal, cortex eliminated behavioral gains from rehabilitative training. In contrast, ANI infusion in the equivalent cortical region of intact animals had no effect on reaching skills. These results suggest that rehabilitative training efficacy for improving manual skills is mediated by synaptic plasticity in a region of motor cortex that, before lesions, is not essential for manual skills, but becomes so as a result of the training. These findings support that experience-driven synaptic structural reorganization underlies functional vicariation in residual motor cortex after motor cortical infarcts.SIGNIFICANCE STATEMENT Stroke is a leading cause of long-term disability. Motor rehabilitation, the main treatment for physical disability, is of variable efficacy. A better understanding of neural mechanisms underlying effective motor rehabilitation would inform strategies for improving it. Here, we reveal synaptic underpinnings of effective motor rehabilitation. Rehabilitative training improved manual skill in the paretic forelimb and induced the formation of special synapse subtypes in coordination with structural changes in astrocytes, a glial cell that influences neural communication. These changes were found in a region that is nonessential for manual skill in intact animals, but came to mediate this skill due to training after stroke. Therefore, motor rehabilitation efficacy depends on synaptic changes that enable remaining brain regions to assume new functions.

Effect of Buffer Conditions and Organic Cosolvents on the Rate of Strain-Promoted Azide-Alkyne Cycloaddition.

We investigate the effect of buffer identity, ionic strength, pH, and organic cosolvents on the rate of strain-promoted azide-alkyne cycloaddition with the widely used DIBAC cyclooctyne. The rate of reaction between DIBAC and a hydrophilic azide is highly tolerant to changes in buffer conditions but is impacted by organic cosolvents. Thus, bioconjugation reactions using DIBAC can be carried out in the buffer that is most compatible with the biomolecules being labeled, but the use of organic cosolvents should be carefully considered.

The Bangladesh paradox: exceptional health achievement despite economic poverty.

Bangladesh, the eighth most populous country in the world with about 153 million people, has recently been applauded as an exceptional health performer. In the first paper in this Series, we present evidence to show that Bangladesh has achieved substantial health advances, but the country's success cannot be captured simplistically because health in Bangladesh has the paradox of steep and sustained reductions in birth rate and mortality alongside continued burdens of morbidity. Exceptional performance might be attributed to a pluralistic health system that has many stakeholders pursuing women-centred, gender-equity-oriented, highly focused health programmes in family planning, immunisation, oral rehydration therapy, maternal and child health, tuberculosis, vitamin A supplementation, and other activities, through the work of widely deployed community health workers reaching all households. Government and non-governmental organisations have pioneered many innovations that have been scaled up nationally. However, these remarkable achievements in equity and coverage are counterbalanced by the persistence of child and maternal malnutrition and the low use of maternity-related services. The Bangladesh paradox shows the net outcome of successful direct health action in both positive and negative social determinants of health--ie, positives such as women's empowerment, widespread education, and mitigation of the effect of natural disasters; and negatives such as low gross domestic product, pervasive poverty, and the persistence of income inequality. Bangladesh offers lessons such as how gender equity can improve health outcomes, how health innovations can be scaled up, and how direct health interventions can partly overcome socioeconomic constraints.

Challenges for philanthropy and tobacco control in China (1986-2012).

OBJECTIVE: To identify the international philanthropies that have invested in tobacco control in China, describe their role and strategies in changing the social norms of tobacco use, and define the outcomes achieved. METHODS: Information on the international philanthropic donor China projects, including activities and outcomes, was gathered from multiple sources including organisational websites, key informant interviews and emails with project officers, and published research papers and reports. RESULTS: Philanthropic donations to China's tobacco control efforts began in 1986. The donors provided funds to national, city, provincial government organisations, non-government organisations, universities, and healthcare organisations throughout China to establish a tobacco control workforce and effective programmes to reduce the burden of tobacco use. CONCLUSIONS: International engagement has been an important dimension of tobacco control in China. Recognising the large burden of illness and capitalising on proven effective control measures, philanthropic organisations understandably seized the opportunity to achieve major health gains. Much of the international philanthropic investment has been directed at public information, policy change and building the Chinese research knowledge base. Documenting research and evaluation findings will continue to be important to ensure that promising practices and lessons learned are identified and shared with the China tobacco control practitioners. The ultimate question is whether foreign philanthropy is making a difference in tobacco control and changing social norms in China? The answer is plainly and simply that we do not know; the evidence is not yet available.

Blockchain-Based Frameworks for Food Traceability: A Systematic Review.

With the rise of globalization and technological competition, the food supply chain has grown more complex due to the multiple players and factors involved in the chain. Traditional systems fail to offer effective and reliable traceability solutions considering the increasing requirement for accountability and transparency in the food supply chain. Blockchain technology has been claimed to offer the food industry a transformative future. The inherent features of blockchain, including immutability and transparency, create a dependable and secure system for tracking food products across the whole supply chain, ensuring total control over their traceability from the origin to the final consumer. This research offers a comprehensive overview of multiple models to understand how the integration of blockchain and other digital technologies has transformed the food supply chain. This comprehensive systematic review of blockchain-based food-supply-chain frameworks aimed to uncover the capability of blockchain technology to revolutionize the industry and examined the current landscape of blockchain-based food traceability solutions to identify areas for improvement. Furthermore, the research investigates recent advancements and investigates how blockchain aligns with other emerging technologies of Industry 4.0 and Web 3.0. Blockchain technology plays an important role in improving food traceability and supply-chain operations. Potential synergies between blockchain and other emerging technologies of Industry 4.0 and Web 3.0 are digitizing food supply chains, which results in better management, automation, efficiencies, sustainability, verifiability, auditability, accountability, traceability, transparency, tracking, monitoring, response times and provenance across food supply chains.

Barriers to blockchain adoption in the seaport industry: A fuzzy DEMATEL analysis.

Blockchain technology, marked as a disruptive force across various sectors, including seaport logistics, faces challenges and obstacles that impede its effective adoption. We aim to empirically identify the significant barriers impeding blockchain adoption in the seaport industry and elucidate the interconnected relationships between these impediments. Utilizing the Fuzzy Decision-Making Trial and Evaluation Laboratory Analysis (Fuzzy DEMATEL) technique, we quantify the cause-and-effect relationships between various barriers to blockchain adoption. Structured interviews involving 18 experts were conducted, collecting both qualitative interview data and quantitative data. The nature of ports and the maritime industry did not seem to be accurately reflected in the literature about blockchain adoption, presenting several new findings in this study. Four primary obstacles were identified: 1) Lack of management support and commitment. 2) Issues in supply chain collaboration, communication and coordination. 3) Resistance from and lack of involvement of external stakeholders. 4) The high cost. Furthermore, cost was reaffirmed as a significant factor influencing blockchain adoption. We enhance existing literature by revealing the interdependencies among identified barriers and offers insights for policymakers and industry practitioners. We aim to foster successful blockchain integration in the seaport industry, improving its sustainability performance. During this research, it has been acknowledged by the business sector that the effective employment of business process re-engineering (BPR) and the strategic implementation of blockchain technology are crucial strategies to surmount the obstacles that have impeded the extensive integration of blockchain within port operations.

Financing health care for all: challenges and opportunities.

India's health financing system is a cause of and an exacerbating factor in the challenges of health inequity, inadequate availability and reach, unequal access, and poor-quality and costly health-care services. Low per person spending on health and insufficient public expenditure result in one of the highest proportions of private out-of-pocket expenses in the world. Citizens receive low value for money in the public and the private sectors. Financial protection against medical expenditures is far from universal with only 10% of the population having medical insurance. The Government of India has made a commitment to increase public spending on health from less than 1% to 3% of the gross domestic product during the next few years. Increased public funding combined with flexibility of financial transfers from centre to state can greatly improve the performance of state-operated public systems. Enhanced public spending can be used to introduce universal medical insurance that can help to substantially reduce the burden of private out-of-pocket expenditures on health. Increased public spending can also contribute to quality assurance in the public and private sectors through effective regulation and oversight. In addition to an increase in public expenditures on health, the Government of India will, however, need to introduce specific methods to contain costs, improve the efficiency of spending, increase accountability, and monitor the effect of expenditures on health.

Multiphoton fluorescence lifetime imaging shows spatial segregation of secondary metabolites in Eucalyptus secretory cavities.

Multiphoton fluorescence lifetime imaging provides an excellent tool for imaging deep within plant tissues while providing a means to distinguish between fluorophores with high spatial and temporal resolution. Ideal candidates for the application of multiphoton fluorescence lifetime imaging to plants are the embedded secretory cavities found in numerous species because they house complex mixtures of secondary metabolites within extracellular lumina. Previous investigations of this type of structure have been restricted by the use of sectioned material resulting in the loss of lumen contents and often disorganization of the delicate secretory cells; thus it is not known if there is spatial segregation of secondary metabolites within these structures. In this paper, we apply multiphoton fluorescence lifetime imaging to investigate the spatial arrangement of metabolites within intact secretory cavities isolated from Eucalyptus polybractea R.T. Baker leaves. The secretory cavities of this species are abundant (up to 10 000 per leaf), large (up to 6 nL) and importantly house volatile essential oil rich in the monoterpene 1,8-cineole, together with an immiscible, non-volatile component comprised largely of autofluorescent oleuropeic acid glucose esters. We have been able to optically section into the lumina of secretory cavities to a depth of ∼80 µm, revealing a unique spatial organization of cavity metabolites whereby the non-volatile component forms a layer between the secretory cells lining the lumen and the essential oil. This finding could be indicative of a functional role of the non-volatile component in providing a protective region of low diffusivity between the secretory cells and potentially autotoxic essential oil.

Transportation capacity shortage influence on logistics performance: evidence from the driver shortage.

The study aims to provide an in-depth analysis of a transportation capacity shortage issue affecting Australian logistics service providers. Transportation capacity shortage is an important issue in all transportation modes. In this study, the driver shortage is viewed as an antecedent variable to estimate the impact of transportation capacity shortage on logistics performance. This study investigates the underlying relationships between driver shortage, logistics capability, and logistics performance according to resource-based theory. Structural equation modeling (SEM) was used to analyze the measurement models and structural model. The empirical results illustrate that driver shortage indirectly influences logistics performance, the logistics capability is a mediator factor in the relationship between driver shortage and logistics performance in logistics service providers. We argue that this provides valuable insights for transportation capacity shortage management.

Pareidolia in a Built Environment as a Complex Phenomenological Ambiguous Stimuli.

Pareidolia is a kind of misperception caused by meaningless, ambiguous stimuli perceived with meaning. Pareidolia in a built environment may trigger the emotions of residents, and the most frequently observed pareidolian images are human faces. Through a pilot experiment and an in-depth questionnaire survey, this research aims to compare built environmental pareidolian phenomena at different time points (6 a.m., 12 p.m., 2 a.m.) and to determine people's sensitivity and reactions towards pareidolia in the built environment. Our findings indicate that the differences in stress level do not influence the sensitivity and reactions towards pareidolia in the built environment; however, age does, and the age of 40 seems to be a watershed. Females are more likely to identify pareidolian faces than males. Smokers, topers, and long-term medicine users are more sensitive to pareidolian images in the built environment. An unexpected finding is that most pareidolian images in built environments are much more easily detected in the early morning and at midnight but remain much less able to be perceived at midday. The results help architects better understand people's reactions to pareidolia in the built environment, thus allowing them to decide whether to incorporate it appropriately or avoid it consciously in building design.

Genomic surveillance of SARS-CoV-2 Omicron variants on a university campus.

Novel variants continue to emerge in the SARS-CoV-2 pandemic. University testing programs may provide timely epidemiologic and genomic surveillance data to inform public health responses. We conducted testing from September 2021 to February 2022 in a university population under vaccination and indoor mask mandates. A total of 3,048 of 24,393 individuals tested positive for SARS-CoV-2 by RT-PCR; whole genome sequencing identified 209 Delta and 1,730 Omicron genomes of the 1,939 total sequenced. Compared to Delta, Omicron had a shorter median serial interval between genetically identical, symptomatic infections within households (2 versus 6 days, P = 0.021). Omicron also demonstrated a greater peak reproductive number (2.4 versus 1.8), and a 1.07 (95% confidence interval: 0.58, 1.57; P < 0.0001) higher mean cycle threshold value. Despite near universal vaccination and stringent mitigation measures, Omicron rapidly displaced the Delta variant to become the predominant viral strain and led to a surge in cases in a university population.

Characterization of Buriti (Mauritia flexuosa) Pulp Oil and the Effect of Its Supplementation in an In Vivo Experimental Model.

Mauritia flexuosa (Buriti) pulp oil contains bioactive substances and lipids that are protective against cardiovascular and inflammatory diseases. We performed physical and chemical analyses to verify its quality and stability. Buriti oil was stable according to the Rancimat test, presenting an induction period of 6.6 h. We evaluated the effect of supplementation with crude buriti oil and olive oil on metabolic parameters in 108 Swiss mice for 90 days. We investigated six groups: extra virgin olive oil (EVOO) 1 and 2 (1000 and 2000 mg/kg), buriti oil (BO) 1 and 2 (1000 and 2000 mg/kg), synergic (S) (BO1 + EVOO1), and control (water dose 1000 mg/kg). The animals were euthanized to examine their blood, livers, and fats. The supplementation did not interfere with food consumption, weight gain, and histological alterations in the liver. Group S showed the strongest relationship with the fractions HDL-c and non-HDL-c, indicating a possible cardioprotective effect. Moreover, we observed significantly higher IL-6 levels in the control, EVOO2, and BO1 groups than in the EVOO1 group. Resistin was also significantly higher for the synergic treatment than for the control. We conclude that BO combined with EVOO could be an excellent food supplement for human consumption.

Acoustic Reflexes in Aural Atresia Patients: Evidence of an Intact Efferent System?

OBJECTIVE: To record crossed acoustic reflex thresholds (xART's) postoperatively from patients after surgical repair of unilateral congenital aural atresia (CAA). To seek explanations for when xARTs can and cannot be recorded. We hope to understand the implications for this central auditory reflex despite early afferent deprivation. METHODS: Patients who underwent surgery to correct unilateral CAA at a tertiary academic medical were prospectively enrolled to evaluate for the presence of xART. Preoperative ARTs in the normal (non-atretic) ear, and postoperative ipsilateral ARTs (stimulus in the normal ear) and contralateral ARTs (stimulus in the newly reconstructed atretic ear; record in the normal ear) were measured at 500, 1000, and 2000 Hz. RESULTS: Four of 11 patients with normal ipsilateral reflex thresholds preoperatively demonstrated crossed acoustic reflexes postoperatively (stimulus in reconstructed ear; record from normal ear). Four other patients demonstrated normal ipsilateral thresholds preoperatively but did not have crossed reflexes postoperatively. No reflexes (pre- or postoperatively) could be recorded in 3 patients. Crossed reflex threshold is significantly correlated with the postoperative audiometric threshold. There was no correlation between ipsilateral and contralateral reflex thresholds. CONCLUSION: Crossed acoustic reflexes can be recorded from some but not all postoperative atresia patients, and the thresholds for those reflexes correlate with the postoperative pure tone threshold. The presence of acoustic reflexes implies an intact CN VIII-to-opposite CN VII central reflex arc despite early unilateral sound deprivation.

Emergence of chronic non-communicable diseases in China.

China has experienced an epidemiological transition shifting from the infectious to the chronic diseases in much shorter time than many other countries. The pace and spread of behavioural changes, including changing diets, decreased physical activity, high rates of male smoking, and other high risk behaviours, has accelerated to an unprecedented degree. As a result, the burden of chronic diseases, preventable morbidity and mortality, and associated health-care costs could now increase substantially. China already has 177 million adults with hypertension; furthermore, 303 million adults smoke, which is a third of the world's total number of smokers, and 530 million people in China are passively exposed to second-hand smoke. The prevalence of overweight people and obesity is increasing in Chinese adults and children, because of dietary changes and reduced physical activity. Emergence of chronic diseases presents special challenges for China's ongoing reform of health care, given the large numbers who require curative treatment and the narrow window of opportunity for timely prevention of disease.

China's human resources for health: quantity, quality, and distribution.

In this paper, we analyse China's current health workforce in terms of quantity, quality, and distribution. Unlike most countries, China has more doctors than nurses-in 2005, there were 1.9 million licensed doctors and 1.4 million nurses. Doctor density in urban areas was more than twice that in rural areas, with nurse density showing more than a three-fold difference. Most of China's doctors (67.2%) and nurses (97.5%) have been educated up to only junior college or secondary school level. Since 1998 there has been a massive expansion of medical education, with an excess in the production of health workers over absorption into the health workforce. Inter-county inequality in the distribution of both doctors and nurses is very high, with most of this inequality accounted for by within-province inequalities (82% or more) rather than by between-province inequalities. Urban-rural disparities in doctor and nurse density account for about a third of overall inter-county inequality. These inequalities matter greatly with respect to health outcomes across counties, provinces, and strata in China; for instance, a cross-county multiple regression analysis using data from the 2000 census shows that the density of health workers is highly significant in explaining infant mortality.

Anxiety and muscle tension as consequences of caffeine withdrawal.

Regular consumers of caffeine had higher muscle tension after three or more hours of abstinence than low caffeine consumers. This difference was absent after double-blind administration of caffeine citrate or placebo. In a discriminative reaction time test, caffeine treatment improved performance. Among subjects receiving placebo, anxiety was highly correlated with prior caffeine use, suggesting that even a brief abstinence may produce anxiety in the regular user.