Health professional education at global scale: The inaugural Lincoln Chen lecture.

This inaugural Lincoln Chen Lecture comments on five themes raised in the International Conference on the Future of Health Professional Education (University of Miami, November 2022), identifies challenges for the future of health professional education, and highlights the contributions and legacy of Lincoln Chen.

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.

Color Vision in the Mountains.

This Lessons from History article uses science, aviation, medicine, and mountaineering sources to describe some of the effects of hypoxia, illumination, and other environmental conditions on the eye, the central nervous system, and light and color perception. The historical perspective is augmented by an analysis of an informal observation of the altered perception of red color on a deck of playing cards while climbing Mera Peak in the Himalaya. The appearance of a grayer red color on the cards was initially attributed to the effects of hypoxia alone. Instead, analysis of cards in combination with the low incidence of protan color vision defects at altitude indicated that glare and contrast effects in the extremely bright lighting environment combined with hypoxia likely caused the perception of a grayer red. The incident provides an educational opportunity for review, analysis, and commentary about some of the complex elements that impact color vision.

How Hospitals Can Save Lives and Themselves: Lessons on Patient Flow From the COVID-19 Pandemic.

COVID-19 has strained hospital capacity, detracted from patient care, and reduced hospital income. This article lays out a tested strategy that surgical and hospital leaders can use to overcome clinical and financial strain, emphasizing the experience at 2 leading North American medical centers. By classifying the time and resource needs of surgical patients and smoothing the flow of surgical admissions over all days of the week, hospitals can dramatically improve hospital efficiency, the quality of care and timely access to care for emergent and urgent surgeries. Through and beyond the time of COVID, smoothing the flow of surgical patients is a key means to restore hospital vitality and improve the care of all patients.

Impact of September 2019 Antarctic Sudden Stratospheric Warming on Mid-Latitude Ionosphere and Thermosphere Over North America and Europe.

Limited observational evidence indicates that ionospheric changes caused by Arctic sudden stratospheric warmings (SSWs) occur at middle latitudes in the Southern Hemisphere. However, it is not known if a similar interhemispheric linkage is produced by Antarctic SSWs. Here we examine thermospheric and ionospheric anomalies observed in September 2019 at middle latitudes in the Northern Hemisphere. We report persistent (at least 30 days) and strong (up to 80%-100%) positive anomalies in the daytime total electron content (TEC) and increases in the thermospheric O/N2 ratio in the western region of North America. However, central and eastern regions of North America experience moderate suppression of TEC reaching 20%-40% of the baseline. Different positive and negative anomalies are observed over the European sector. We hypothesize that regional differences in the TEC response could be related to modulation of thermospheric winds during SSWs, changes in thermospheric composition, and differences in declination angle.

The Death Zone: Lessons from History.

This Lessons from History article about the naming of the extreme altitude "Death Zone" explores the historical mountaineering and medical literature relevant to the topic. Swiss alpinist and radiologist Edouard Wyss-Dunant (1897-1983) authored several reports and books about expeditions to arctic regions, deserts, and the Himalaya. Encouraged by the success of a Swiss expedition to the Garhwal Himalaya in 1947, Wyss-Dunant joined his fellow climbers from Geneva on a 1949 expedition to several peaks in the Kanchenjunga region. Wyss-Dunant was then invited to lead the spring 1952 Swiss Everest expedition. Despite this being the first Swiss attempt on Everest and on an untried route, Raymond Lambert and Tenzing Norgay nearly summitted Everest from the Nepal side. Wyss-Dunant earned mountaineering immortality by coining the phrase the Death Zone during the expedition's foray into the upper regions of Everest. Wyss-Dunant went on to become a president of the Swiss Alpine Club and the International Climbing and Mountaineering Federation. His writings and that of others provide an evocative supporting narrative to illustrate some of the problems of living (or dying) at extreme altitude.

The Wind-Chill Index.

This Lessons from History article about the wind-chill index (WCI) explores the historical polar and meteorologic literature relevant to the topic and presents unpublished work from 1939. Geographer Paul Siple (1908-1968) was a 6-time Antarctic explorer and scientist who invented and named the WCI in his doctoral dissertation at Clark University. Siple and Charles Passel (1915-2002) performed studies in Antarctica in 1940 that led to publication in 1945. This paper is often credited as the beginning of the WCI. Through years of critiques and revisions by others, these efforts evolved into the wind-chill equivalent temperatures (WCTs) used today. This essay explores the history, the science, and the overlooked originality, simplicity, and details of Siple's unpublished work. The remarkable similarity of the original chart to a current chart is shown by adapting and overlaying the 1939 WCI onto a current WCT chart with its times-to-frostbite data. The writings of Siple, Passel, and others provide an evocative supporting narrative to illustrate some of the problems of living in cold environmental conditions.

High Altitude Deterioration: A Historical Essay.

This wilderness essay about high altitude deterioration will explore the historical mountaineering and medical literature with a limited discussion of physiology. The writings of mountaineers and physician-mountaineers provide an evocative supporting narrative to illustrate one of the problems of living at altitude.

Dull Brains and Frozen Feet: A Historical Essay on Cold.

This essay will review historical and medical aspects of cold exposure, hypothermia, and frostbite during the Napoleonic era. The 19th century writings of Dominique Jean Larrey, Pierre Jean Moricheau-Beaupré, and others are used to provide an evocative supporting narrative to illustrate some of the cold illnesses, physiology, and theory of both an earlier era and the present time. Medical care for over a century followed the how but not the why of treating frostbite and hypothermia slowly with snow or cold water rather than heat. There were 2 main reasons: First was a practical attempt to limit gangrene. Less known, and long forgotten, is a major rationale based on the erroneous theory of heat called "the caloric." Because of these 2 reasons, the slow method of "cold warming" remained standard medical practice well into the 20th century. Although these recommendations are now known to be flawed, some of the reasons behind them will be discussed, along with early but correct observations on afterdrop and circumrescue collapse. There is a long backstory of treatment from 1812 to the present.

The return on investment of implementing a continuous monitoring system in general medical-surgical units.

OBJECTIVES: To evaluate the cost savings attributable to the implementation of a continuous monitoring system in a medical-surgical unit and to determine the return on investment associated with its implementation. DESIGN: Return on investment analysis. SETTING: A 316-bed community hospital. PATIENTS: Medicine, surgery, or trauma patients admitted or transferred to a 33-bed medical-surgical unit. INTERVENTIONS: Each bed was equipped with a monitoring unit, with data collected and compared in a 9-month preimplementation period to a 9-month postimplementation period. MEASUREMENTS AND MAIN RESULTS: Two models were constructed: a base case model (A) in which we estimated the total cost savings of intervention effects and a conservative model (B) in which we only included the direct variable cost component for the final day of length of stay and treatment of pressure ulcers. In the 5-year return on investment model, the monitoring system saved between $3,268,000 (conservative model B) and $9,089,000 (base model A), given an 80% prospective reimbursement rate. A net benefit of between $2,687,000 ($658,000 annualized) and $8,508,000 ($2,085,000 annualized) was reported, with the hospital breaking even on the investment after 0.5 and 0.75 of a year, respectively. The average net benefit of implementing the system ranged from $224 per patient (model B) to $710 per patient (model A) per year. A multiway sensitivity analyses was performed using the most and least favorable conditions for all variables. In the case of the most favorable conditions, the analysis yielded a net benefit of $3,823,000 (model B) and $10,599,000 (model A), and for the least favorable conditions, a net benefit of $715,000 (model B) and $3,386,000 (model A). The return on investment for the sensitivity analysis ranged from 127.1% (25.4% annualized) (model B) to 601.7% (120.3% annualized) (model A) for the least favorable conditions and from 627.5% (125.5% annualized) (model B) to 1739.7% (347.9% annualized) (model A) for the most favorable conditions. CONCLUSIONS: Implementation of this monitoring system was associated with a highly positive return on investment. The magnitude and timing of these expected gains to the investment costs may justify the accelerated adoption of this system across remaining inpatient non-ICU wards of the community hospital.