Estimating The Effects Of COVID-19 On Globalized Markets For Active Pharmaceutical Ingredients.

Global supply chains for active pharmaceutical ingredients (APIs) are highly centralized in certain countries and are susceptible to supply-chain shocks. However, there is no systematic monitoring or global coordination to manage risk and ensure equitable supply continuity during public health emergencies. In this study, we applied quasi-experimental methods on shipment-level customs data to determine how prices and export volume for APIs exported from India were affected by the COVID-19 pandemic. We found that API prices for key essential medicines not used for COVID-19 did not change significantly in the year after the World Health Organization pandemic declaration, but volume decreased by 80 percent. Prices for medicines speculatively repurposed for COVID-19, such as hydroxychloroquine and ivermectin, increased by as much as 250 percent compared with prices for nonrepurposed medicines, but only ivermectin saw a decrease in volume. Systematic monitoring of API markets, investments to promote supply diversification, and legal and political reforms to disincentivize price speculation could support supply-chain resilience and safeguard access to medicines.

Management from a multidisciplinary perspective of phlebitis related to peripheral venous catheter insertion: An international Delphi study.

AIM: To determine the consensus and importance of care practices related to the management of peripheral venous catheter (PVC)-related phlebitis in hospitalized patients through the views of experts from different disciplines. BACKGROUND: PVCs are commonly used in hospitals but are associated with complications such as phlebitis. Their management differs widely, and studies are heterogeneous. DESIGN: Delphi method. METHODS: Four stages: problem area (with Web of Science bibliometric review in July 2022), panel members, two Delphi rounds and closing criteria. In the Delphi survey, experts answered an online questionnaire based on assessment, treatment and follow-up dimensions (September 2022-February 2023). Statistical analyses were conducted of frequencies, percentages, measures of central tendency and levels of dispersion (QD). A space for comments was created, and a thematic analysis conducted of them. RESULTS: Eighteen experts (nurses, doctors and pharmacists) participated in the Delphi rounds. Forty-five activities were identified: 19 in assessment, 15 in treatment and 11 in follow-up. A high consensus level (QD ≤ 0.6) was found in five activities (11.12%), moderate level (0.6 < QD < 1.0) in 19 (42.22%) and low level (QD > 1.0) in 21 (46.66%). Seven themes were determined (patient perspective, lack of consensus, low evidence-based practices, stage-based treatments, prevention activities, high variability in practice and specialist teams and interdisciplinary work). CONCLUSION: The importance of systematic assessment scales is highlighted together with consensus on signs and symptoms (pain, redness, inflammation, palpable cord and induration). Treatment according to severity and daily visual recording and monitoring are emphasized along with the need for patient participation and healthcare literacy. A high level of consensus was obtained in 11% of the activities, showing the large variability of criteria and interventions for phlebitis management. Highlighted needs include working in a team, the use of specialist teams and promoting evidence- and prevention-based activities. RELEVANCE TO CLINICAL PRACTICE: Clinical variability is noted and, therefore, the importance of consensus on standardized care for PVC phlebitis and evidence-based practice. REPORTING METHOD: Delphi studies (CREDES). PATIENT OR PUBLIC CONTRIBUTION: Experts contribution.

Quantifying global redundant fisheries trade to streamline seafood supply chains.

Seafood plays an important role in sustainably feeding the world and is one of the most traded food products globally. However sustainability improvements are often focused on its production (e.g., aquaculture, fishing) rather than trade. Here, we quantify the magnitude and extent of global 'redundant two-way' seafood trade-the exchange of the same quantity of the same taxonomic species between two countries-to examine its prevalence and potential implications across the seafood supply chain. We focused on wild-caught seafood trade and found that redundant two-way trade has increased by 43%, between 2000 and 2015, making up 3.2% (7.7 Mt) of global seafood trade during that period. Although most countries were involved in redundant two-way seafood trade (111 of 212 analyzed), the majority occurred between five trade partners: Canada and the United States (15%), Germany and the Netherlands (11.8%); Denmark and Sweden (10.6%); Germany and Denmark (7.1%); and France and Norway (7%). Nearly 50% of redundant trade is made up of just four species including Atlantic herring, Atlantic cod, Skipjack tuna and Atlantic mackerel. While deficiencies in global seafood trade data mask seasonal and product heterogeneity, redundant trade could have implications for meeting conservation and sustainable development goals. Future research should build upon these findings to explore specific environmental, economic, and social implications associated with redundant two-way trade to benefit producers and consumers within the seafood supply chain.

[Need for improvement in the care of patients with Clostridioides difficile infections (CDI) - expert opinion in international comparison]. / Verbesserungsbedarf in der Versorgung von Patienten/-innen mit Clostridioides-difficile-lnfektionen (CDI) ­ Experten/-innenmeinung im internationalen Vergleich.

INTRODUCTION: Clostridioides difficile infection (CDI), as a nosocomial disease, is associated with high morbidity and mortality. Even though the incidence of CDI has been declining in Germany in recent years, the individual infection may pose a medical challenge despite therapeutic advances. The aim here is to clarify which gaps practitioners consider to be particularly serious in care and in the existing evidence base. METHODS: In a moderated workshop of German CDI experts the topics considered as relevant were identified. A survey already conducted in five other countries (Australia, France, Great Britain, Canada, and Italy) was adapted and processed by 27 practitioners. During the evaluation, the topics perceived as particularly important were identified, the statements of the specialist groups were compared and changes in opinion were considered. RESULTS: 27 fully completed questionnaires were evaluated. The need for improvement was primarily seen in the prevention of CDI recurrences (74.1%) and the treatment of recurrences (55.6%). Evidence deficits were noted in the treatment of recurrences (55.6%) and identification of risk factors for recurrences (48.1%). Improving care via fecal microbiota transfer (FMT) was named by 70.4%. For guidelines, more clarity (48.1%) and more regular updates (40.7%) were desired. For patients, better education on appropriate antibiotic use (52.0%) and choice of FMT were desired (48.1%). SUMMARY: The German expert view and the international assessment is similar, when asked about the need for improvement in care and evidence gaps in the treatment of patients with CDI: The focus is on prevention and therapy of recurrent CDI. The problem of access to FMT is a German peculiarity that seems to need improvement.

An international delphi survey and consensus meeting to define the risk factors for ureteral stricture after endoscopic treatment for urolithiasis.

PURPOSE: Iatrogenic ureteral strictures (US) after endoscopic treatment for urolithiasis represent a significant healthcare concern. However, high-quality evidence on the risk factors associated with US is currently lacking. We aimed to develop a consensus statement addressing the definition, risk factors, and follow-up management of iatrogenic US after endoscopic treatment for urolithiasis. METHODS: Utilizing a modified Delphi method, a steering committee developed survey statements based on a systematic literature review. Then, a two-round online survey was submitted to 25 experts, offering voting options to assess agreement levels. A consensus panel meeting was held for unresolved statements. The predetermined consensus threshold was set at 70%. RESULTS: The steering committee formulated 73 statements. In the initial survey, consensus was reached on 56 (77%) statements. Following in-depth discussions and refinement of 17 (23%) statements in a consensus meeting, the second survey achieved consensus on 63 (86%) statements. This process underscored agreement on pivotal factors influencing US in endoscopic urolithiasis treatments. CONCLUSIONS: This study provides a comprehensive list of categorized risk factors for US following endoscopic urolithiasis treatments. The objectives include enhancing uniformity in research, minimizing redundancy in outcome assessments, and effectively addressing risk factors associated with US. These findings are crucial for designing future clinical trials and guiding endoscopic surgeons in mitigating the risk of US.

Unlocking time-quantile impact of energy vulnerability, financial development, and political globalization on environmental sustainability in Turkey: Evidence from different pollution indicators.

Increasing energy vulnerability can cause environmental pollution by increasing fossil fuel consumption. If it leads to cost-cutting-oriented industry growth, financial development can lead to environmental regulations being ignored, compromising environmental quality. Political globalization and economic growth can increase short-term environmental pressures, straining long-term ecological balance and causing habitat loss and pollution. This study investigates the impact of energy vulnerability, financial development, and political globalization on environmental sustainability in Turkey for the 2000-2019 period using with wavelet quantile-based techniques. According to results, while the negative effect of energy vulnerability on environmental quality is lower in the short term, the size of the effect increases in the medium and long term. In addition, at low quantiles of environmental quality, the negative effect of financial development is low in the short and long term, while the effect becomes evident in the long term. Moreover, the effects of political globalization on environmental quality are positive in all quantiles. Additionally, the harmful effects of economic growth are more evident at lower quantiles of environmental quality. Turkey should increase its clean energy investments by using its geographically advantageous location. Policymakers should also prioritize environmental regulations and promote sustainable practices in industries. Incentives for cleaner production technologies and environmentally friendly initiatives can help steer the financial sector towards more responsible and environmentally friendly practices. Additionally, the study suggests that increasing institutional capacity and aligning national policies with international agreements can accelerate the positive effects of political globalization.

Learning from an experience, challenges and approaches in the workplace during COVID-19 pandemic: a content analysis of international documents.

BACKGROUND: This study aims to investigate international measures for pandemic control in the workplace based on guidelines from international organizations to learn from their experiences. METHODS: We conducted a qualitative study using content analysis. The search method involved reviewing published guidelines on preventing and responding to the COVID-19 pandemic in workplaces. After the screening process, ten guidelines were included in the content analysis. During the analysis, 200 meaning codes, 49 subcategories, and eleven categories were identified. Trustworthiness criteria were utilized to ensure the accuracy and strength of the findings. RESULTS: Eleven categories of international content during the COVID-19 pandemic were legal requirements and duties of employees and employers, structural and program changes, risk assessment, risk communication, information and training, internal and external consultation and cooperation, provision of facilities and tools for workplace hygiene, special conditions, special groups, closing and reopening workplaces, reducing contact and exposure and mental health. CONCLUSIONS: Protecting employees during a pandemic requires a multifaceted approach and strong advocacy. The operational plan for pandemic control should be developed based on the level of risk, with support tailored to employees' conditions and needs. Cooperation among international organizations is essential to develop a standardized plan and issue comprehensive guidelines in response to health emergencies with a global perspective and local implementation, drawing from the lessons learned during the COVID-19 pandemic.

The enduring world forest carbon sink.

The uptake of carbon dioxide (CO2) by terrestrial ecosystems is critical for moderating climate change1. To provide a ground-based long-term assessment of the contribution of forests to terrestrial CO2 uptake, we synthesized in situ forest data from boreal, temperate and tropical biomes spanning three decades. We found that the carbon sink in global forests was steady, at 3.6 ± 0.4 Pg C yr-1 in the 1990s and 2000s, and 3.5 ± 0.4 Pg C yr-1 in the 2010s. Despite this global stability, our analysis revealed some major biome-level changes. Carbon sinks have increased in temperate (+30 ± 5%) and tropical regrowth (+29 ± 8%) forests owing to increases in forest area, but they decreased in boreal (-36 ± 6%) and tropical intact (-31 ± 7%) forests, as a result of intensified disturbances and losses in intact forest area, respectively. Mass-balance studies indicate that the global land carbon sink has increased2, implying an increase in the non-forest-land carbon sink. The global forest sink is equivalent to almost half of fossil-fuel emissions (7.8 ± 0.4 Pg C yr-1 in 1990-2019). However, two-thirds of the benefit from the sink has been negated by tropical deforestation (2.2 ± 0.5 Pg C yr-1 in 1990-2019). Although the global forest sink has endured undiminished for three decades, despite regional variations, it could be weakened by ageing forests, continuing deforestation and further intensification of disturbance regimes1. To protect the carbon sink, land management policies are needed to limit deforestation, promote forest restoration and improve timber-harvesting practices1,3.

Quantifying economic vulnerabilities induced by interdependent networks.

Under economic globalization, countries are linked through trade and investments. This economic interdependence creates vulnerabilities. The indirect vulnerability induced by interdependent networks of trade and investments can put a country's economy at risk, but this risk has yet to be systematically quantified and investigated. In this paper, we developed the novel Potential Indirect Vulnerability Index (PIVI) to capture how interdependencies between networks of trade and foreign direct investment (FDI) may induce economic vulnerabilities. The model consisted of three main components: a target country (the importer of goods), an investing country (the exporter of FDI), and the intermediary countries that export commodities to the target country and receive FDI from the investing country, serving as conduits of the vulnerabilities caused indirectly by the investing country. The PIVI quantifies the indirect vulnerabilities based on the product of two fractions: 1) the dependency of the target country on commodities from each intermediary country; and 2) the dependency of each intermediary country on FDI from the investing country. We demonstrated the utility of PIVI by examining the US economy's vulnerability to China using 2019 trade and FDI data. Several Asian countries and a mix of agricultural products and raw materials were identified as conduits through which China could potentially influence the US economy. Vietnam was a sizeable risk because, while it has been a primary source of many US imports, it also received about 30% of its FDI from China. The US policy makers might opt to increase diversity in trade partners or to promote investment in countries such as Vietnam. We also applied the PIVI analysis to critical minerals, identifying cobalt, tungsten, and copper as the most vulnerability-inducing among them. PIVI is a flexible metric than can be aggregated and modified to provide a more nuanced and focused assessment of an economy's vulnerability.

Oldest southern sauropterygian reveals early marine reptile globalization.

Sauropterygians were the stratigraphically longest-ranging clade of Mesozoic marine reptiles with a global fossil record spanning ∼180 million years1. However, their early evolution has only been known from what is now the Northern Hemisphere, extending across the northern and trans-equatorial western margins of the Tethys paleo-ocean1 after the late-Early Triassic (late Olenekian, ∼248.8 million years [Ma] ago2), and via possible trans-Arctic migration1 to the Eastern Panthalassa super-ocean prior to the earliest Middle Triassic (Olenekian-earliest Anisian3,4, ∼247 Ma). Here, we describe the geologically oldest sea-going reptile from the Southern Hemisphere - a nothosaur (basal sauropterygian5) from the Middle Triassic (Anisian, after ∼246 Ma6) of New Zealand. Time-scaled ancestral range estimations thus reveal an unexpected circum-Gondwanan high-paleolatitude (>60° S7) dispersal from a northern Tethyan origination center. This coincides with the adaptive diversification of sauropterygians after the end-Permian mass extinction8 and suggests that rapid globalization accompanied their initial radiation in the earliest Mesozoic.

Parenteral nutrition in clinical practice: International challenges and strategies.

PURPOSE: Parenteral nutrition (PN) is an established therapy when oral/enteral feeding is not sufficient or is contraindicated, but nevertheless PN remains a complex, high-alert medication that is susceptible to errors that may affect patient safety. Over time, considerable progress has been made to make PN practices safer. The purpose of this article is to address ongoing challenges to improve the PN use process from prescription to administration and monitoring, and to outline practical aspects fostering the safety, quality, and cost-effectiveness of PN, as discussed at the International Safety and Quality of PN Summit. SUMMARY: Opportunities to improve the PN use process in clinical practice include the promotion of inter-disciplinary communication, vigilant surveillance for complications, staff education to increase competency, and more consistent use of advanced technologies that allow automated safety checks throughout the PN process. Topics covered include considerations on PN formulations, including the value of intravenous lipid emulsions (ILEs), trends in compounding PN, the current and future role of market-authorized multi-chamber PN bags containing all 3 macronutrients (amino acids, glucose/dextrose, and ILE) in the United States and in Europe, and strategies to cope with the increasing global problem of PN product shortages. CONCLUSION: This review outlines potential strategies to use in clinical practice to overcome ongoing challenges throughout the PN use process, and ultimately promote PN patient safety.

Strategies for launching streaming content: Assessing movie-country relatedness and its impact on international popularity.

The study proposes a way to measure the relatedness between countries and movies (movie-country relatedness density) and to test whether this relatedness is an important factor in predicting the popularity of a movie in a certain country. The results show that both movie-country relatedness density and movie ubiquity (i.e., popularity across many countries) are positively associated with a movie appearing in a country's top 20 list even after considering other covariates. Based on these findings, we suggest an OTT (Over-the-tops) movie launching strategy with regard to movie-country relatedness density for both global and local OTT companies. Our study contributes to a growing body of research on movie consumption patterns and provides insights into the factors that determine a movie's success on a global scale. The importance of cultural similarity in adopting films and television shows is widely recognized, but the concept of movie-country compatibility is introduced to take into account the content attributes that cannot be explained by cultural differences. The results suggest that movies that are related to other popular movies in a given country and movies that are popular across many countries are more likely to appear in a country's top 20 list.

Did the organization of primary care practices during the COVID-19 pandemic influence quality and safety? - an international survey.

BACKGROUND: Changes in demographics with an older population, the illness panorama with increasing prevalence of non-communicable diseases, and the shift from hospital care to home-based care place demand on primary health care, which requires multiprofessional collaboration and team-based organization of work. The COVID-19 pandemic affected health care in various ways, such as heightened infection control measures, changing work practices, and increased workload. OBJECTIVES: This study aimed to investigate the association between primary care practices' organization, and quality and safety changes during the COVID-19 pandemic. DESIGN: Data were collected from 38 countries in a large online survey, the PRICOV-19 study. For this paper, the participating practices were categorized as "Only GPs", comprising practices with solely general practitioners (GPs) and/or GP trainees, without any other health care professionals (n = 1,544), and "Multiprofessional," comprising practices with at least one GP or GP trainee and one or more other health professionals (n = 3,936). RESULTS: Both categories of practices improved in infection control routines when compared before and during the COVID-19 pandemic. A larger proportion of the multiprofessional practices changed their routines to protect vulnerable patients. Telephone triage was used in more "Multiprofessional" practices, whereas "Only GPs" were more likely to perform video consultations as an alternative to physical visits. Both types of practices reported that the time to review new guidelines and scientific literature decreased during the pandemic. However, both had more meetings to discuss directives than before the pandemic. CONCLUSIONS: Multiprofessional teams were keener to introduce changes to the care organization to protect vulnerable patients. However, practices with only GPs were found to be more aligned with video consultations, perhaps reflecting the close patient-doctor relationship. In contrast, telephone triage was used more in multiprofessional teams.

Do circular economy, renewable energy, industrialization, and globalization influence environmental indicators in belt and road initiative countries?

This paper is the first comprehensive research to examine the effect of circular economy on environment employing two environmental degradation indicators (CO2 emissions, ecological footprint) and one environmental quality indicator (load capacity factor) for 57 Belt and Road Initiative (BRI) countries during 2000-2019. The effect of other variables such as renewable energy, industrialization, and globalization was also controlled. The study applied the cross-sectional autoregressive distributed lag method (CS-ARDL), the augmented mean group (AMG), and common correlated effects mean group (CCEMG) methods as a robustness checks. The empirical findings reveal that circular economy and renewable energy have pro-environmental effects by decreasing carbon emissions and ecological footprint and increasing the load capacity factor in BRI countries. However, industrialization and globalization have detrimental effects on the environment. The result of causality shows a bidirectional causality between renewable energy, circular economy, industrialization, and three environmental indicators, but the relationship of globalization with CO2 emissions and the load capacity factor is unidirectional and with the ecological footprint is bidirectional. All the results are confirmed by the robustness tests. The study suggests policy implications for the BRI government.