Advancing the decadal plan for the science of nutrition: Progressing a framework for implementation.

AIMS: In 2019, the Australian Academy of Science in collaboration with the nutrition community published the decadal plan for the science of nutrition. This article aims to review progress towards each of its pillar goals (societal determinants, nutrition mechanisms, precision and personalised nutrition, and education and training) and two enabling platforms (a national data capability and a trusted voice for nutrition science), prioritise actions, and conceptualise program logic implementation models. This process also brought together public health nutrition researchers to reflect on societal determinants of health, and advise how the next 5 years of the decadal plan could reflect contemporary issues. METHODS: Two engagement events, in 2023, brought together experienced and mid- and early-career nutrition professionals for co-creation of implementation logic models. RESULTS: One hundred and nine early and mid-career professionals were involved. A revised model for the decadal plan pillars emerged from synthesis of all logic models. This new model integrated the precision and personalised nutrition pillar with nutrition mechanisms pillar. These combined pillars build towards the national data capability enabling platform and created new cross-cutting themes for education and training. The need arose for greater focus on respectful engagement with Aboriginal and Torres Strait Islander communities and sustained effort to build cross-disciplinary collaboration to realise the plan's societal determinants goals. A new alliance for nutrition science is proposed to become a unified advocacy voice and build trust in nutrition professionals. CONCLUSIONS: A programmatic approach provides a road map for implementing the decadal plan for the final 5 years.

Identifying and costing common gaps in Central and West Africa pharmaceutical regulation.

Background: Regulatory systems strengthening is crucial for catalyzing access to safe and effective medical products and health technologies (MPHT) for all. Identifying and addressing common regulatory gaps through regional approaches could be instrumental for the newly incepted African Medicine Agency. Aims: This original study sheds light on common gaps among 10 national regulatory authorities (NRAs) and ways to address them regionally. Objectives: The study used NRA self-assessment outcomes to identify common gaps in four critical regulatory pillars and estimate the cost of addressing them from regional perspectives that aimed at raising the maturity level of regulatory institutions. Methods: A cross-sectional study, using the WHO Global Benchmarking Tool (GBT), was conducted between 2020 and 2021 with five NRAs from ECCAS and ECOWAS member states that use French and Spanish as lingua franca. Results: The 10 NRAs operated in a non-formal-to-reactive approach (ML1-2), which hinders their ability to ensure the quality of MPHT and respond appropriately to public health emergencies. Common gaps were identified in four critical regulatory pillars-good regulatory practices, preparedness for public health emergencies, quality management systems, and substandard and falsified medical products-with overall cost to address gaps estimated at US$3.3 million. Contribution: We elaborated a reproducible method to strengthen regulatory systems at a regional level to improve equitable access to assured-quality MPHT. Our bottom-up approach could be utilized by RECs to address common gaps through common efforts.

Enhancing Colonoscopy Preparation in Elderly Constipation Patients: A Personalized Approach with PEG and Exercise - A Case Study.

This study aimed to optimize bowel preparation efficacy for colonoscopy in elderly constipation patients. A 71-year-old patient with chronic constipation and a history of poor bowel preparation. To address these challenges, we implemented a personalized strategy combining of PEG administration and walking exercise. The PEG was administered according to a protocol, with intermittent exercise breaks of 10 minute. Bowel cleanliness was assessed using the Boston Bowel Preparation Scale (BBPS). Adverse reactions and tolerance were closely monitored throughout the intervention. The patient's BBPS score improved from 3 to 8 post-intervention. The exercise intervention was well-tolerated (rating I), and mild nausea was observed only after the first PEG dose. No severe adverse reactions occurred. Subsequent Follow-up revealed symptom relief. The personalized approach combining (PEG and exercise intervention) successfully improved bowel preparation quality in the elderly constipation patient undergoing colonoscopy. This approach considers age-related changes in gastrointestinal function and activity level, offering an effective strategy to improve patient tolerance and reduce adverse reactions during bowel preparation. The findings underscore the importance of tailoring interventions for elderly constipation patients to optimize the colonoscopy experience.

Minimum library size determination for RapidPlan knowledge based planning system using multicriteria optimization.

OBJECTIVES: The aim of this study was to determine the number of trade-off explored (TO) library plans required for building a RapidPlan (RP) library that would generate the optimal clinical treatment plan. METHOD: We developed two RP models, one each for the two clinical sites, head neck (HN) and cervix. The models were created using 100 plans and were validated using 70 plans (VP) for each site respectively. Each of the two libraries comprising 100 TO plans were divided into five different subsets of library plans comprising of 20, 40, 60, 80, and 100 plans, leading to five different RP model for each site. For every validation patient, a TO plan (TO_VP) was created. For every patient, five RP-plans were automatically generated using RP models. The dosimetric parameters of the six plans (TO_VP + five RP-plans) were compared using Pearson correlation and Greenhouse-Geisser analysis. RESULTS: PTV D95% in six competing plans varied between 97.6±0.7% and 98.1±0.6% in HN cases and 98.8±0.3% and 99.0±0.4% in cervix cases. Overall, for both sites the mean variations in OAR doses or volumes were within 50cGy, 0.5% and 0.2cc between library plans, and if TO_VP was included the variations deteriorated to 180 cGy, 0.4% and 15cc. All OARs in both sites, except D0.1 ccspine, showed a statistically insignificant variation between all plans. CONCLUSION: Dosimetric variation among various output plans generated from five RapidPlan libraries is minimal and clinically insignificant. The optimal output plan can be derived from the least weighted library consisting of 20 plans. ADVANCES IN KNOWLEDGE: This article shows that, when the constituent plans are subjected to trade-off exploration, the number of constituent plans for a knowledge-based planning module is not relevant in terms of its dosimetric output.

[Hot weather and health risks in the focus of the Hessian health authorities : Inspection and consultation of residential care and nursing facilities since 2004]. / Hitzeschutz im Fokus der hessischen Betreuungs- und Pflegeaufsicht : Beratung und Prüfung stationärer Einrichtungen seit dem Jahr 2004.

BACKGROUND AND AIMS: Heat extremes are associated with considerable health risks, especially for vulnerable groups. To counteract these risks, public health policy calls for protective measures to be linked to heat warnings. Such links do not generally exist in Germany, with the exception of the heat inspections and consultations carried out by the Hessian health authorities since 2004. The aims of this work were to identify the structures and processes of the Hessian heat inspections and heat consultations and to derive findings for acute response to heat in residential care and nursing facilities. METHODS: We conducted 14 qualitative, semi-structured interviews with experts from the Hessian health authorities as well as with managers of residential care and nursing facilities. The analysis of the interview protocols was carried out using content-structuring qualitative content analysis. In addition, documents from the supervisory authority were analyzed. RESULTS: Every year, up to 370 heat inspections are carried out in the approximately 2500 inpatient facilities in Hesse. They are either integrated into already planned inspections or carried out separately; they focus on preventive and acute measures. In principle, heat protection can be easily integrated into the daily routine of residential health facilities. High staff turnover and lack of resources pose challenges. DISCUSSION: Inspections and consultations on heat management raise awareness of hot weather health risks and support the establishment of preventive measures. The Hessian system is a suitable orientation for other federal states.

Impact of shared decision-making on women's childbirth preferences: A cluster randomised controlled trial.

BACKGROUND: Midwives provide counselling for birth plans (BPs) to women during prenatal care; however, the impact of individualised BP counselling interventions based on shared decision-making (SDM) regarding women's preferences is unknown. METHODS: This randomised cluster trial included four primary healthcare units. Midwives provided BP counselling based on SDM to women in the intervention group (IG) during prenatal care along with a handout about evidence-based recommendations. Women in the control group (CG) received standard BP counselling from midwives. The main outcome was preference changes concerning BPs. RESULTS: A total of 461 (95.5 %) pregnant women received BP counselling (IG, n = 247; CG, n = 214). Women in the IG changed their BP preferences for 13 items compared with those in the CG. These items were: using an unique space during birth (81.1 % vs 51.6 %; p < 0.001), option for light graduation (63 % vs 44.7 %; p < 0.001), listening to music (57.3 % vs 43.6 %; p = 0.006), drinking fluids during labour (84.6 % vs 93.6 %; p = 0.005), continuous monitoring (59 % vs 37.8 %; p < 0.001); desire for natural childbirth (36.6 % vs 25 %; p = 0.014), epidural analgesia (55.1 % vs 43.6 %; p = 0.023); breathing techniques (65.2 % vs 50.5 %; p = 0.003), massage (74.9 % vs 55.3 %; p < 0.001); birthing ball use (81.9 % vs 56.9 %; p < 0.001), spontaneous pushing (49.3 % vs 28.7 %; p < 0.001), choosing birth position (69.6 % vs 41.5 %) and delayed umbilical cord clamping (67.8 % vs 44.1 %; p = 0.001). CONCLUSION: SDM counselling, together with a handout about evidence-based recommendations on childbirth and newborn care, produced more changes in women's preferences expressed in the BP than standard counselling.

Natural hazard risk analysis in the framework of water safety plans.

The available literature on natural hazard risk analysis focused on the implementation of water safety plans (WSPs) is surprisingly quite poor, despite the significant increase in the number and severity of disasters and adverse effects on drinking water supply systems generated by natural hazards. At the same time, WSPs that conveniently account for natural hazards with a comprehensive approach 'from source to tap' are still scarce as they typically occur at larger spatial scales and adequate prevention, mitigation and adaptation require efficient inter-institutional collaborations. The aim of this paper is to highlight the main bottlenecks for water utilities to include natural hazards in the development of their WSPs. The research adopted a stakeholders-oriented approach, involving a considerable number of water utilities (168), water sectoral agencies (15) and institutions (68) across the Adriatic-Ionian Region through a stepwise process that generated joint SWOT analysis, the development of a decision support system (DSS) focused on WSPs procedures and tabletop exercises. The final outcomes generated strategic documents (REWAS - Adrion Road map for resilient water supply) that highlighted the necessity for efficient cross-sectoral and inter-institutional cooperation in the development of well-founded and robust WSPs to address natural hazard risk analysis for water supply systems (DWSS).

The effect of core competencies of university students on employment and first year salary level based on school activity log.

Deciding on a career and securing employment at an ideal company represent significant challenges for students. Employment is not only a personal achievement but also a measure of success for universities and governments. To transform students into competitive applicants, various activities are provided by universities, governments, and companies. These activities may leave students either excited about the prospects or overwhelmed by the experience. The aim of this study is to explore the relationship between college experiences and post-graduation employment through an analysis of a five-year activity log. Specifically, students' diverse activities were categorized into six core competencies: skill reinforcement, leadership and teamwork, globalization, organizational commitment, job exploration, and autonomous implementation. We used logistic regression to examine how these competencies relate to employment status, and ANOVA analysis to assess their impact on initial salaries. The findings reveal that while competencies in skill improvement, job exploration, and organizational commitment were not statistically significant, those in leadership and teamwork, globalization, and autonomous implementation were crucial for securing employment. Additionally, globalization, job exploration, and autonomous implementation competencies influenced annual salary levels. Furthermore, a comparison of students completing either a single major or a convergent major revealed that job exploration competency significantly impacts the annual salary level.

Diversity Plans and Postmarketing Studies: First Impressions of Anticipated Diversity Requirements in the United States.

INTRODUCTION: Recent Food and Drug Administration (FDA) draft guidelines are intended to improve representation and formalize the assessment of race and ethnicity in drug development, but how regulators and industry stakeholders plan to implement and enforce new requirements is still being determined. MATERIALS AND METHODS: Here, a 10-question survey was developed to assess the experiences of industry stakeholders in developing diversity plans. These survey results informed an analysis of postmarketing studies to understand how diversity requirements have been enforced to date. RESULTS AND DISCUSSION: Among 13 survey responders, experience submitting and receiving feedback on diversity plans was limited. A variety of challenges have been associated with developing these plans, including questions regarding regulatory guidance. Sponsors have utilized several data sources, including real-world datasets, to define enrollment goals. Diversity-related postmarketing studies most commonly related to oncologic diseases, and endpoints frequently related to efficacy. Most marketing applications associated with diversity-related postmarketing studies received Orphan drug designation (ODD) and Accelerated Approval. CONCLUSIONS: These results show that industry experience with diversity plans remains limited in the absence of finalized regulatory guidance. Sponsors are beginning to develop strategies for submitting diversity plans, which include identifying key functions and data sources to support enrollment goals, although definitive conclusions were difficult to draw from the small responder pool. In the postmarketing setting, studies are already underway to improve the understanding of racial and ethnic differences in responses to approved drugs. Development programs relating to oncology, which has historically suffered from a lack of diverse representation, have been a primary focus of such studies thus far.

Qualitative evaluation of artificial intelligence-generated weight management diet plans.

Importance: The transformative potential of artificial intelligence (AI), particularly via large language models, is increasingly being manifested in healthcare. Dietary interventions are foundational to weight management efforts, but whether AI techniques are presently capable of generating clinically applicable diet plans has not been evaluated. Objective: Our study sought to evaluate the potential of personalized AI-generated weight-loss diet plans for clinical applications by employing a survey-based assessment conducted by experts in the fields of obesity medicine and clinical nutrition. Design setting and participants: We utilized ChatGPT (4.0) to create weight-loss diet plans and selected two control diet plans from tertiary medical centers for comparison. Dietitians, physicians, and nurse practitioners specializing in obesity medicine or nutrition were invited to provide feedback on the AI-generated plans. Each plan was assessed blindly based on its effectiveness, balanced-ness, comprehensiveness, flexibility, and applicability. Personalized plans for hypothetical patients with specific health conditions were also evaluated. Main outcomes and measures: The primary outcomes measured included the indistinguishability of the AI diet plan from human-created plans, and the potential of personalized AI-generated diet plans for real-world clinical applications. Results: Of 95 participants, 67 completed the survey and were included in the final analysis. No significant differences were found among the three weight-loss diet plans in any evaluation category. Among the 14 experts who believed that they could identify the AI plan, only five did so correctly. In an evaluation involving 57 experts, the AI-generated personalized weight-loss diet plan was assessed, with scores above neutral for all evaluation variables. Several limitations, of the AI-generated plans were highlighted, including conflicting dietary considerations, lack of affordability, and insufficient specificity in recommendations, such as exact portion sizes. These limitations suggest that refining inputs could enhance the quality and applicability of AI-generated diet plans. Conclusion: Despite certain limitations, our study highlights the potential of AI-generated diet plans for clinical applications. AI-generated dietary plans were frequently indistinguishable from diet plans widely used at major tertiary medical centers. Although further refinement and prospective studies are needed, these findings illustrate the potential of AI in advancing personalized weight-centric care.

Impact of overdose on health plan disenrollment among patients prescribed long-term opioids: Retrospective cohort study.

CONTEXT: Health plan disenrollment may disrupt chronic or preventive care for patients prescribed long-term opioid therapy (LTOT). PURPOSE: To assess whether overdose events in patients prescribed LTOT are associated with subsequent health plan disenrollment. DESIGN: Retrospective cohort study. SETTING AND DATASET: Data from the Optum Labs Data Warehouse which includes de-identified medical and pharmacy claims and enrollment records for commercial and Medicare Advantage enrollees. The database contains longitudinal health information on patients, representing a mixture of ages and geographical regions across the United States. PATIENTS: Adults prescribed stable opioid therapy (≥10 morphine milligram equivalents/day) for a 6-month baseline period prior to an index opioid prescription from January 1, 2018 to December 31, 2018. MAIN MEASURES: Health plan disenrollment during follow-up. RESULTS: The cohort comprised 404,151 patients who were followed up after 800,250 baseline periods of stable opioid dosing. During a mean follow-up of 9.1 months, unadjusted disenrollment rates among primary commercial beneficiaries and Medicare Advantage enrollees were 37.2 and 13.9 per 100 person-years, respectively. Incident overdoses were associated with subsequent health plan disenrollment with a statistically significantly stronger association among primary commercial insurance beneficiaries [adjusted incidence rate ratio (aIRR) 1.48 (95% CI: 1.33-1.64)] as compared to Medicare Advantage enrollees [aIRR 1.15 (95% CI: 1.07-1.23)]. CONCLUSIONS: Among patients prescribed long-term opioids, overdose events were strongly associated with subsequent health plan disenrollment, especially among primary commercial insurance beneficiaries. These findings raise concerns about the social consequences of overdose, including potential health insurance loss, which may limit patient access to care at a time of heightened vulnerability.

Trends and postoperative outcomes of thyroidectomy after expansion and rise of health insurance deductibles in the fiscal year.

BACKGROUND: The purpose of this study is to evaluate a relationship between expansion of High Deductible Health Plans (HDHPs) and the number of thyroid surgery cases with associated postoperative outcomes in the fiscal year. METHODS: Data from TriNetX was used to evaluate the trends in thyroid surgery from 2005 and 2021 between the end of the year (Quarter 4) and the beginning of the year (Quarter 1). Risk of postoperative outcomes were statistically interrogated. RESULTS: The average rate of thyroid surgery in cases/year between Quarter 4 and Quarter 1 was similar after expansion of HDHPs (152; 146; p = 0.64). There was no increased risk of postoperative complications. The rate of surgery decreased significantly for patients with Medicare after implementation of the revised American Thyroid Association (ATA) guidelines (Quarter 4: p = 0.03; Quarter 1: p = 0.02). CONCLUSIONS: Patients are less likely to delay thyroid surgery at the end of the year despite higher deductibles.

Study on decision-making for orthodontic treatment plans based on analytic hierarchy process.

BACKGROUND: Orthodontics is a common treatment for malocclusion and is essential for improving the oral health and aesthetics of patients. Currently, patients often rely on the clinical expertise and professional knowledge of doctors to select orthodontic programs. However, they lack their own objective and systematic evaluation methods to quantitatively compare different programs. Therefore, there is a need for a more comprehensive and quantitative approach to selecting orthodontic treatment plans, aiming to enhance their scientific validity and effectiveness. METHODS: In this study, a combination of the analytic hierarchy process (AHP) and semantic analysis was used to evaluate and compare different orthodontic treatment options. An AHP model and evaluation matrix were established through thorough research and semantic analysis of patient requirements. This model considered various treatment factors. Expert panels were invited to rate these factors using a 1-9 scale. The optimal solution was determined by ranking and comparing different orthodontic treatment plans using the geometric mean method to calculate the weights of each criterion. RESULTS: The research indicates a higher preference for invisible correction compared to other orthodontic solutions, with a weight score that is 0.3923 higher. Factors such as comfort and difficulty of cleaning have been given significant attention. CONCLUSION: The Analytic Hierarchy Process (AHP) method can be utilized to effectively develop orthodontic treatment plans, making the treatment process more objective, scientific, and personalized. The design of this study offers strong decision support for orthodontic treatment, potentially improving orthodontic treatment outcomes in clinical practice and ultimately enhancing oral health and patients' quality of life.

An optimization model for monthly time-step drilling schedule under planned field production.

The field production profile over the yearly horizon is planned for a balance between economy, security, and sustainability of energy. An optimal drilling schedule is required to achieve the planned production profile with minimized drilling frequency and summation. In this study, we treat each possible production process of each well as a dependent time series and the basic unit. Then we ensemble all of them into a tensor. Based on formulated tensor calculation and Lasso regularization, a linear mathematical optimization model for well drilling schedule was developed. The model is aimed at minimizing production profile error while optimizing drilling frequency and summation. Although the model proposed in this work requires more memory consumption to be solved using a computer, it is assured as a linear model and could be numerically globally solved in a stable and efficient way using gradient descent, avoiding complex nonlinear programming problems. Main input data and parameters involved in the model are analyzed in detail to understand the effects of different production parameters on the drilling schedule and production profile. The proposed model in this work can evaluate the manual drilling schedule and automatically generate an optimized drilling schedule for the gas field, significantly reducing development plan formulation time.

Biosecurity Insights from the United States Swine Health Improvement Plan: Analyzing Data to Enhance Industry Practices.

Biosecurity practices aim to reduce the frequency of disease outbreaks in a farm, region, or country and play a pivotal role in fortifying the country's pork industry against emerging threats, particularly foreign animal diseases (FADs). This article addresses the current biosecurity landscape of the US swine industry by summarizing the biosecurity practices reported by the producers through the United States Swine Health Improvement Plan (US SHIP) enrollment surveys, and it provides a general assessment of practices implemented. US SHIP is a voluntary, collaborative effort between industry, state, and federal entities regarding health certification programs for the swine industry. With 12,195 sites surveyed across 31 states, the study provides a comprehensive snapshot of current biosecurity practices. Key findings include variability by site types that have completed Secure Pork Supply plans, variability in outdoor access and presence of perimeter fencing, and diverse farm entry protocols for visitors. The data also reflect the industry's response to the threat of FADs, exemplified by the implementation of the US SHIP in 2020. As the US SHIP program advances, these insights will guide industry stakeholders in refining biosecurity practices, fostering endemic re-emerging and FAD preparedness, and ensuring the sustainability of the swine industry in the face of evolving challenges.

Patient and relative experiences of the ReSPECT process in the community: an interview-based study.

BACKGROUND: The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) was launched in the UK in 2016. ReSPECT is designed to facilitate meaningful discussions between healthcare professionals, patients, and their relatives about preferences for treatment in future emergencies; however, no study has investigated patients' and relatives' experiences of ReSPECT in the community. OBJECTIVES: To explore how patients and relatives in community settings experience the ReSPECT process and engage with the completed form. METHODS: Patients who had a ReSPECT form were identified through general practice surgeries in three areas in England; either patients or their relatives (where patients lacked capacity) were recruited. Semi-structured interviews were conducted, focusing on the participants' understandings and experiences of the ReSPECT process and form. Data were analysed using inductive thematic analysis. RESULTS: Thirteen interviews took place (six with patients, four with relatives, three with patient and relative pairs). Four themes were developed: (1) ReSPECT records a patient's wishes, but is entangled in wider relationships; (2) healthcare professionals' framings of ReSPECT influence patients' and relatives' experiences; (3) patients and relatives perceive ReSPECT as a do-not-resuscitate or end-of-life form; (4) patients' and relatives' relationships with the ReSPECT form as a material object vary widely. Patients valued the opportunity to express their wishes and conceptualised ReSPECT as a process of caring for themselves and for their family members' emotional wellbeing. Participants who described their ReSPECT experiences positively said healthcare professionals clearly explained the ReSPECT process and form, allocated sufficient time for an open discussion of patients' preferences, and provided empathetic explanations of treatment recommendations. In cases where participants said healthcare professionals did not provide clear explanations or did not engage them in a conversation, experiences ranged from confusion about the form and how it would be used to lingering feelings of worry, upset, or being burdened with responsibility. CONCLUSIONS: When ReSPECT conversations involved an open discussion of patients' preferences, clear information about the ReSPECT process, and empathetic explanations of treatment recommendations, working with a healthcare professional to co-develop a record of treatment preferences and recommendations could be an empowering experience, providing patients and relatives with peace of mind.

Large-scale dose evaluation of deep learning organ contours in head-and-neck radiotherapy by leveraging existing plans.

Background and purpose: Retrospective dose evaluation for organ-at-risk auto-contours has previously used small cohorts due to additional manual effort required for treatment planning on auto-contours. We aimed to do this at large scale, by a) proposing and assessing an automated plan optimization workflow that used existing clinical plan parameters and b) using it for head-and-neck auto-contour dose evaluation. Materials and methods: Our automated workflow emulated our clinic's treatment planning protocol and reused existing clinical plan optimization parameters. This workflow recreated the original clinical plan (POG) with manual contours (PMC) and evaluated the dose effect (POG-PMC) on 70 photon and 30 proton plans of head-and-neck patients. As a use-case, the same workflow (and parameters) created a plan using auto-contours (PAC) of eight head-and-neck organs-at-risk from a commercial tool and evaluated their dose effect (PMC-PAC). Results: For plan recreation (POG-PMC), our workflow had a median impact of 1.0% and 1.5% across dose metrics of auto-contours, for photon and proton respectively. Computer time of automated planning was 25% (photon) and 42% (proton) of manual planning time. For auto-contour evaluation (PMC-PAC), we noticed an impact of 2.0% and 2.6% for photon and proton radiotherapy. All evaluations had a median ΔNTCP (Normal Tissue Complication Probability) less than 0.3%. Conclusions: The plan replication capability of our automated program provides a blueprint for other clinics to perform auto-contour dose evaluation with large patient cohorts. Finally, despite geometric differences, auto-contours had a minimal median dose impact, hence inspiring confidence in their utility and facilitating their clinical adoption.

Reinforcement during the COVID-19 pandemic: Perception of nursing students and impact on intention to drop-out of nursing education.

Background: Although the COVID-19 pandemic's impact on students has already been studied, its impact on nursing students' perception of their training and their conception of their future profession is unknown. Aims: To describe nursing students' perception of their involvement in reinforcement during the COVID-19 pandemic and the impact of working as reinforcement staff during the COVID-19 pandemic on nursing students. Design: Cross-sectional, comparative case/non-case study. Setting: nurse training institutions in France. Participants: "Cases" defined as nursing students who worked as reinforcement staff during the COVID-19 pandemic; "non-cases" defined as people who were in final year of nursing studies in 2018-2019 or 2019-2020 and so did not work as reinforcement staff during their nursing studies. Methods: questionnaire about representations of the nursing profession, role of the nurse in society, previous thinking of dropping out of nursing education. Results: 534 subjects included (310 cases; 214 non-cases). Cases reported feeling useful (38.6%) or very useful (25.7%) as reinforcement workers, while 91.5% concurred that nurses had an important role in the management of COVID-19 patients. Cases more frequently reported that the nursing profession is one where you save lives (61.5% vs 52.5%, p = 0.05). The desire to work as a nurse for a whole life had been more frequently expressed by cases (45.3% vs 34.8%, p = 0.05). Nursing education drop-out has been considered by 63.4% of subjects, without difference between "cases" and "non-cases" (p = 0.63). Subjects who considered dropping out of nursing education were younger (p = 0.01) and less often prone to think that the nursing profession was a profession personally rewarding (p = 0.01) and a life-saving profession (p = 0.03). Conclusion: The majority of nursing students reported feeling useful during the pandemic, and underlined the importance of the nurse's role in management of COVID-19 patients. Participation in reinforcement staff during the pandemic had no influence on dropping out of nursing education.

Identifying carbon sequestration's priority supply areas from the standpoint of ecosystem service flow: A case study for Northwestern China's Shiyang River Basin.

Finding important supply areas helps maintain the ecological security of the region and promotes the creation of healthy ecosystems. By considering the ecosystem service flows (ESF), priority provisioning area studies can be approached from a new perspective. This study describes the real supply in terms of flows. The goal was to reveal the priority-ranked supply pattern of ecosystem carbon sequestration services (ECSS) in the Shiyang River Basin (SRB). First and foremost, soil respiration models and Carnegie-Ames-Stanford Approach (CASA) model were used to examine the supply of ECSS, and a combination of natural and human factors was used to determine the demand for ECSS. Second, Python was used to illustrate the ECSS flow trajectories and flows. Lastly, and utilized in conjunction with System Conservation Planning (SCP) to determine supply regions of importance. The results show that, first, the spatial distribution of ECSS supply and demand clearly demonstrates heterogeneity. This is reflected in the spatial characteristics of supply, which are "high in the south and low in the north," and demand, which is "high in the urban areas and low in the suburbs." Second, the middle and lower portions of the basin, where there is little precipitation and little vegetation, are home to the majority of the locations with poor carbon sequestration fluxes. These areas accounted for almost 60 % of the entire watershed area over time. Third, the first priority area of ECSS occupies 19.3 % of the basin's total area, while the second priority area occupies 21.46 %. For the major supply regions, strict ecological protection laws must be implemented going forward in order to ensure the ability to sustain ECSS supply. The long-term growth of SRB as well as ecological and environmental management can benefit from this research's foundational role in policymaking.

[Educational trajectory of forensic medical expert in the system of continuous medical education]. / Obrazovatel'naya traektoriya sudebno-meditsinskogo eksperta v sisteme nepreryvnogo meditsinskogo obrazovaniya.

The objective of the study is to determine the possibility and the right to choose the directions of self-education and self-development by forensic medical experts within the framework of personal and professional development program in the educational trajectory formation. The materials of special and encyclopaedic literature including pedagogical and sociological sciences, as well as legal framework regulating the processes of continuing medical education have been studied. The choice of educational trajectory of forensic physician depending on personal benchmarks, self-education building and participation in educational activities has been defined.