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Parenteral and enteral nutrition support are key components of care for various medical and physiological conditions in infants, children, and adults. Nutrition support practices have advanced over time, driven by the goals of safe and sufficient delivery of needed nutrients and improved patient outcomes. These advances have been, and continue to be, dependent on research and development studies. Such studies address aspects of enteral and parenteral nutrition support: formulations, delivery devices, health outcomes, cost-effectiveness, and related metabolism. The studies are supported by public funding from the government and by private funding from foundations and from the nutrition support industry. To build public trust in nutrition support research findings, it is important to underscore ethical research conduct and reporting of results for all studies, including those with industry sponsors. In 2019, American Society for Parenteral and Enteral Nutrition's (ASPEN's) Board of Directors established a task force to ensure integrity in nutrition support research that is done as collaborative partnerships between the public (government and individuals) and private groups (foundations, academia, and industry). In this ASPEN Position Paper, the Task Force presents principles of ethical research to guide administrators, researchers, and funders. The Task Force identifies ways to curtail bias and to minimize actual or perceived conflict of interests, as related to funding sources and research conduct. Notably, this paper includes a Position Statement to describe the Task Force's guidance on Public-Private Partnerships for research and funding. This paper has been approved by the ASPEN Board of Directors.

Urinary incontinence is a common problem among older adults that is often complicated by many nuanced ethical considerations. Unfortunately, there is a lack of guidance for healthcare professionals on how to navigate such concerns. This International Continence Society white paper aims to provide healthcare professionals with an ethical framework to promote best care practices in the care of older adults with urinary incontinence.

The Veterans Health Administration (VHA) is the United States' largest integrated health care delivery system, serving over 9 million enrollees at nearly 1300 health care facilities. In addition to providing health care to the nation's military veterans, the VHA has a research and development program, trains thousands of medical residents and other health care professionals, and conducts emergency preparedness and response activities. The VHA has been celebrated for delivering high-quality care to veterans, early adoption of electronic medical records, and high patient satisfaction. However, the system faces challenges, including implementation of an expanded community care program, modernization of its electronic medical records system, and providing care to a population with complex needs. The position paper offers policy recommendations on VHA funding, the community care program, medical and health care professions training, and research and development.

The steady growth of corporate interest and influence in the health care sector over the past few decades has created a more business-oriented health care system in the United States, helping to spur for-profit and private equity investment. Proponents say that this trend makes the health care system more efficient, encourages innovation, and provides financial stability to ensure access and improve care. Critics counter that such moves favor profit over care and erode the patient-physician relationship. American College of Physicians (ACP) underscores that physicians are permitted to earn a reasonable income as long as they are fulfilling their fiduciary responsibility to provide high-quality, appropriate care within the guardrails of medical professionalism and ethics. In this position paper, ACP considers the effect of mergers, integration, private equity investment, nonprofit hospital requirements, and conversions from nonprofit to for-profit status on patients, physicians, and the health care system.

The pulp and paper industry has significant sustainability implications and necessarily requires a careful consideration of direct and lower-tier suppliers for effective sustainable supply chain ma...

The World One Health Congresses are biennial gatherings of approximately 1500 professionals from relevant international organisations, OIE, FAO, WHO, World Bank, leading scientific experts and researchers in the field of One Health, animal production and trade, food safety, animal health, human health and environmentology/ecology, government representatives in public health, human health, food safety, environmental health and global health security. The Congress is organized by the One Health Platform.This white paper summarizes highlights of the 5th International One Health Congress in Saskatoon, Canada, June 2018 and serves as a roadmap for the future, detailing several concrete action points to be carried out in the run-up to the 6th World One Health Congress in Edinburgh, Scotland, June 2020.

Context: Scientific studies are often presented primarily to a group of colleagues at annual scientific meetings. All year rounds are turned into products in congresses. Aims: The aim of the study is to evaluate the extent of the hand surgery in plastic surgery and plastic surgeons' papers related with hand surgery in national congresses; the past eight plastic surgery congresses were classified and presented. Settings and Design: The abstract books of Turkish National Congresses of Plastic, Reconstructive, and Aesthetic Surgery between 2011 and 2018 have been evaluated retrospectively. Subjects and Methods: Distribution of hand surgery according to the topics was evaluated according to the European White Book rules and standards. Distribution of oral and posters and distribution by years were shown. Results: The ratio of hand surgery reports to all reports was 17.3%. Hand and upper extremity surgery topics were presented at 19.7% in the 38th congress, which is the most hand surgery-included congress. The most frequently presented subjects were tumors, flaps, trauma, congenital anomalies, and replantation. Conclusions: Although there are arguments that plastic surgeons have disregarded hand surgery, there is no similar situation for Turkish plastic surgeons in the national platform. It has been found that the most common topics such as tumor excision and repair of the tissue defect were the most presented issues rather than arthroscopy, paralytic hand, and arthritis, which are specific to the hand surgery. Increasing the number of plastic surgery specialists who have been trained with hand surgery as a subspecialty will bring up the subjects that have not been presented in the hand surgery so far, in the future congresses.

Quality training in pediatric gastroenterology, hepatology, and nutrition is essential for the future of our specialty from advancing the science through research to providing clinical care for children with gastrointestinal, hepatic and nutritional disorders. As educational theory has developed, both the American Board of Pediatrics (ABP) and the Accreditation Council for Graduate Medical Education (ACGME) have commissioned projects to better define training including core competencies, and milestones with the goal of competency-based assessment. Seeking to provide a clinical context for these competencies and milestones, the ABP commissioned a project for each pediatric subspecialty to develop entrustable professional activities (EPA) while at the same time developing EPAs that are common to all pediatric subspecialties. North American Society for Pediatric Gastroenterology, Hepatology, Nutrition (NASPGHAN) commissioned an EPA Task Force to develop the pediatric gastroenterology, hepatology and nutrition EPAs. This document serves as an introduction to EPAs, including their historical background, underlying educational theory, and the process used to develop the pediatric gastroenterology, hepatology and nutrition EPAs in the United States of America.

Gender disparity exists in leadership roles within healthcare. While the majority of the healthcare workforce is comprised of women, significantly fewer women occupy leadership positions, particularly at executive and board levels. As the field of oncology pharmacy continues to rapidly expand and evolve, an assessment of the current state of women in oncology pharmacy leadership roles is vital to the growth and development of the profession. In the fall of 2017, the Hematology/Oncology Pharmacy Association (HOPA) hosted a summit to explore leadership issues facing women in oncology pharmacy which have the potential to affect our membership and our profession. This meeting included invited participants from across the fields of oncology and pharmacy and was part of HOPA’s strategic leadership initiative developed through the work of the HOPA Leadership Development Committee in 2016. This promotes a primary goal of HOPA, which is to support oncology pharmacists as they assume leadership roles within their practices and within healthcare to assure oncology pharmacy is integrated into cancer care. The purpose of this white paper is to (1) summarize key issues that were identified through a membership survey; (2) review ongoing efforts to address the needs of female oncology pharmacists in leadership development; (3) serve as a call to action for individuals and professional organizations to assist with and disseminate these efforts and highlight available resources, and (4) to provide practical steps to meet the needs of individuals, training programs, and institutions/employers.

Recently, the Association of University and College Counseling Center Directors (AUCCCD) published a White Paper on a multidimensional understanding of organizational structures for counseling cent...

This ESC Council on Stroke/EAPCI/EBNI position paper summarizes recommendations for training of cardiologists in endovascular treatment of acute ischaemic stroke. Interventional cardiologists adequately trained to perform endovascular stroke interventions could complement stroke teams to provide the 24/7 on call duty and thus to increase timely access of stroke patients to endovascular treatment. The training requirements for interventional cardiologists to perform endovascular therapy are described in details and should be based on two main principles: (i) patient safety cannot be compromised, (ii) proper training of interventional cardiologists should be under supervision of and guaranteed by a qualified neurointerventionist and within the setting of a stroke team. Interdisciplinary cooperation based on common standards and professional consensus is the key to the quality improvement in stroke treatment.

Objective The aims of this study were to understand the status quo of authors, collaborations between institutions, research hotspots, and research frontiers of fund-sponsored clinical nursing papers and to provide a reference for Chinese scholars to conduct clinical nursing studies in the future. Methods The visualization software CiteSpace was used to analyze fund-sponsored clinical nursing papers published between 2012 and 2016 in 12 core journals of nursing. Results In the clinical nursing field, there are many cooperative author groups; however, the collaborations between institutions are not close and exist mainly within the same province or city. High-frequency keywords have revealed the four clinical nursing research hotspots of population, diseases, nursing intervention, and others. Chinese medicine nursing, prevention, treatment and nursing, and new technology-aided nursing of ventilator-associated pneumonia are the study frontiers of clinical nursing. Conclusions Clinical nursing studies are rich in content and cover a wide range of areas, and their hotspots and frontiers are closely related to the requirements of clinical nursing. Collaborations across regions, provinces, and cities are not adequate; there is an urgent need to strengthen the cross-regional exchanges and collaborations to promote the further development of clinical nursing.

ESSKA is constantly committed to promoting the improvement of scientific quality through the publication of books and the organization of dedicated conferences. In line with this commitment, this interview paper was crated with the aim of being useful for all the young scientists and orthopaedics keen in musculoskeletal and sport medicine research. Three Editors from the most important journals in our field were invited to participate: Jon Karlsson from Knee Surgery Sport Traumatology and Arthroscopy, Bruce Reider from The American Journal of Sport Medicine and Edward Wojtys from Sports Health.

BackgroundThere is a clear gender gap in scientific authorship. Although the proportions of female authors in medicine and psychiatry have increased over the past decades, women are still underrepresented.AimsTo analyse authorship gender trends in eating disorder research.MethodFirst and last author gender in research articles on eating disorders during the period 1997–2016 were assessed in eating disorder specialty journals, high-impact psychiatry journals and high-impact clinical psychology journals.ResultsThe total number of papers on eating disorders increased substantially over the observation period, although a decrease was observed in high-impact psychiatry journals. Female authorship increased in both specialty journals and high-impact psychiatry journals. Authors were significantly less likely to be female in high-impact psychiatry and clinical psychology journals than in speciality journals.ConclusionsEating disorder research has been increasingly allocated to specialty journals over the past 20 years. A consistent gender gap between specialty and high-impact journals exists.Declaration of interestC.M.B is a grant recipient from Shire Pharmaceuticals, Inc. and has participated as a member of their scientific advisory board. These positions are unrelated to the content of this article.

Background: Though women increasingly make up the majority of medical-school and other science graduates, they remain a minority in academic biomedical settings, where they are less likely to hold leadership positions or be awarded research funding. A major factor is the career breaks that women disproportionately take to see to familial duties. They experience a related, but overlooked, hurdle upon their return: they are often too old to be eligible for 'early-career researcher' grants and 'career-development' awards, which are stepping stones to leadership positions in many institutions and which determine the demographics of their hierarchies for decades to come. Though age limits are imposed to protect young applicants from more experienced seniors, they have an unintended side effect of excluding returning workers, still disproportionately women, from the running. Methods: In this joint effort by the European Society of Clinical Microbiology and Infectious Diseases, the Federation of European Microbiological Societies, the Infectious Disease Society of America, the International Society for Infectious Diseases and the Swiss Society for Infectious Diseases, we invited all European Congress of Clinical Microbiology and Infectious Diseases-affiliated medical societies and funding bodies to participate in a survey on current 'early-career' application restrictions and measures taken to provide protections for career breaks. Recommendations: The following simple consensus recommendations are geared to funding bodies, academic societies and other organizations for the fair handling of eligibility for early-career awards: 1. Apply a professional, not physiological, age limit to applicants. 2. State clearly in the award announcement that career breaks will be factored into applicants' evaluations such that: • Time absent is time extended: for every full-time equivalent of career break taken, the same full-time equivalent will be extended to the professional age limit. • Opportunity costs will also be taken into account: people who take career breaks risk additional opportunity costs, with work that they did before the career break often being forgotten or poorly documented, particularly in bibliometric accounting. Although there is no standardized metric to measure additional opportunity costs, organizations should (a) keep in mind their existence when judging applicants' submissions, and (b) note clearly in the award announcement that opportunity costs of career breaks are also taken into account. 3. State clearly that further considerations can be undertaken, using more individualized criteria that are specific to the applicant population and the award in question. The working group welcomes feedback so that these recommendations can be improved and updated as needed.

Vaccination rates of children in the United States remain below the target coverage levels identified in the Healthy People 2020 objectives. Given the success of pharmacists in providing adult vaccinations and the accessibility of pharmacists to the public, expanding pharmacists' authority to vaccinate children may improve vaccination rates of children, particularly in key disease states. This article serves as a Position Statement of the Pediatric Pharmacy Advocacy Group (PPAG), who supports the expansion of pharmacists' authority to vaccinate children. PPAG also believes that increased use of state vaccination registries by pharmacists will help improve communication and documentation of vaccines between providers. PPAG also recommends that continued education and maintaining current knowledge of vaccines and vaccine schedules are vital for pharmacist immunizers. Finally, PPAG believes that pharmacists should be advocates for childhood vaccinations.

In this study, we investigated the antibacterial activity of silver-coated gold nanoparticles (Au-Ag NPs) immobilized on cellulose paper. Ag NPs are known to have strong antibacterial properties, while Au NPs are biocompatible and relatively simple to prepare. We made the Au-Ag NPs using a facile process called Ag enhancement, in which Au NPs serve as the nuclei for precipitation of a Ag coating, the thickness of which can be easily controlled by varying the ratio of the reactants. After synthesis, electron microscopy showed that the Au-Ag NPs displayed a core-shell structure, and that they could be successfully immobilized onto a cellulose membrane by heat treatment. We then investigated the antibacterial properties of this NP-coated cellulose paper against E. coli JM109. The inhibition rate, growth curve, and AATCC 100 activity test showed that cellulose paper coated with 15 nm Au-Ag NPs possessed excellent antibacterial activity against E. coli JM109. These results suggest that Au-Ag NPs immobilized on cellulose paper could be a valuable antibacterial technology for applications such as food packaging, clothing, wound dressings, and other personal care products.

This paper aims to develop a construction and operation cost model of wastewater treatment for the paper industry in China and explores the main factors that determine these costs. Previous models mainly involved factors relating to the treatment scale and efficiency of treatment facilities for deriving the cost function. We considered the factors more comprehensively by adding a regional variable to represent the economic development level, a corporate ownership factor to represent the plant characteristics, a subsector variable to capture pollutant characteristics, and a detailed-classification technology variable. We applied a unique data set from a national pollution source census for the model simulation. The major findings include the following: (1) Wastewater treatment costs in the paper industry are determined by scale, technology, degree of treatment, ownership, and regional factors; (2) Wastewater treatment costs show a large decreasing scale effect; (3) The current level of pollutant discharge fees is far lower than the marginal treatment costs for meeting the wastewater discharge standard. Key implications are as follows: (1) Cost characteristics and impact factors should be fully recognized when planning or making policies relating to wastewater treatment projects or technology development; (2) There is potential to reduce treatment costs by centralizing wastewater treatment via industrial parks; (3) Wastewater discharge fee rates should be increased; (4) Energy efficient technology should become the future focus of wastewater treatment.

On August 9–10, 2017, the American College of Surgeons hosted a symposium on metabolic surgery, with 12 follow-on papers published serially in the Bulletin of the College. The current synopsis outlines the varied contents of these papers, often in the original words of their authors, who are cited within their topic sections. Topics covered include the following: history and definition of metabolic surgery, bariatric surgery, international bariatric surgery, mechanisms of metabolic surgery, diabetes and the metabolic syndrome, frontiers of metabolic surgery, institutional collaborations, accreditations and quality initiatives, professional training, the role of the National Institutes of Health, and advocacy. Based on these insights, an enthusiastic affirmation for the future of metabolic surgery is warranted.

Myxovirus protein A (MxA) is a biomarker that can be used to distinguish between viral and bacterial infections. While MxA lateral flow assays (LFAs) have been successfully used for viral vs. bacterial differential diagnosis for children, the clinically relevant level of MxA for adults has been reported to be 100 times lower, which is too low for traditional LFAs. We present results applying the use of surface enhanced Raman spectroscopy (SERS) to detect MxA. AuAg nanoshells (AuAg NSs) were used to enhance the Raman signal of mercaptobenzoic acid (4-MBA), enabling readout by SERS. The AuAg NSs were conjugated to antibodies for the biomarker of interest, resulting in a “nanotag”, that could be used in a dipstick immunoassay for detection. We first optimized the nanotag parameters using anti-human IgG/human IgG as a model antibody/antigen system, and then demonstrated detection of MxA using anti-MxA antibodies. We show that SERS readout of immunoassays for MxA can quantify MxA levels at clinically relevant levels for adult viral infection., This work was carried out within the “Doctorat en Quìmica” PhD programme of Universitat Autònoma de Barcelona, supported by the Spanish MINECO (MAT2015-70725-R) and from the Catalan Agència de Gestió d'Ajuts Universitaris i de Recerca (AGAUR) (2017-SGR-143). Financial support from the HISENTS (685817) Project financed by the European Community under H20202 Capacities Programme is gratefully acknowledged. It was also funded by the CERCA Program/Generalitat de Catalunya. ICN2 acknowledges the support of the Spanish MINECO through the Severo Ochoa Centers of Excellence Program under Grant SEV2201320295. CRQ was funded by a Rafael del Pino Fellowship, a UMass Boston Beacon Student Success Fellowship and a Goranson Award. BML was funded by a fellowship from Ronald E. McNair grant (P217A170241), Beacon Student Success Fellowship, and an Oracle/Sanofi student fellowship.

The purpose of this position paper by the South African Academy of Family Physicians (SAAFPs) is to inform decision making on human resources for health policy in South Africa and the placement of family physicians (FPs) in the district health system. National policies have been marred by misunderstanding of the roles and contribution of FPs; and there is unhelpful variability in how FPs are positioned in the health services between provinces. In the private sector, medical aid schemes have discriminated against FPs by failing to remunerate them as specialists and to recognise their scope of practice.

Terms used to label types of clinical recommendations and guidance are applied inconsistently and do not reflect the methods used to create each type. Here, the international Pediatric Oncology Supportive Care Guideline Network proposes a lexicon for types of recommendations and guidance documents. A lexicon describing three types of recommendations (clinical practice guideline-derived, good practice statement, and expert opinion statement) and two types of guidance documents (clinical practice guideline and expert opinion) is presented. Consistent use of this lexicon will allow pediatric oncology clinicians to readily appreciate the methods used to create clinical guidance.

Risk adjustment is critical in the comparison of quality of care and health care outcomes for providers. Electronic health records (EHRs) have the potential to eliminate the need for costly and time-consuming manual data abstraction of patient outcomes and risk factors necessary for risk adjustment.Leading EHR vendors and hospital focus groups were asked to review risk factors in the New York State (NYS) coronary artery bypass graft (CABG) surgery statistical models for mortality and readmission and assess feasibility of EHR data capture. Risk models based only on registry data elements that can be captured by EHRs (one for easily obtained data and one for data obtained with more difficulty) were developed and compared with the NYS models for different years.Only 6 data elements could be extracted from the EHR, and outlier hospitals differed substantially for readmission but not for mortality. At the patient level, measures of fit and predictive ability indicated that the EHR models are inferior to the NYS CABG surgery risk model [eg, c-statistics of 0.76 vs. 0.71 (P0.001) and 0.76 vs. 0.74 (P=0.009) for mortality in 2010], although the correlation of the predicted probabilities between the NYS and EHR models was high, ranging from 0.96 to 0.98.A simplified risk model using EHR data elements could not capture most of the risk factors in the NYS CABG surgery risk models, many outlier hospitals were different for readmissions, and patient-level measures of fit were inferior.

Reforming of hydrocarbon which is an important hydrogen production method proceeds in two steps, i.e. steam reforming and shift reaction. Due to different thermodynamics, the two reactions are conventionally conducted at different temperatures. This study examines one step methane reforming by use of proton-conducting electrochemical cell in combination with a reforming catalyst. Promotion of the reforming reaction was intended by extracting hydrogen via electrochemical hydrogen pumping with a proton conductor cell. In order to compensate for the slow kinetics of the steam reforming, a paper catalyst loaded with Ni was placed in front of the electrochemical cell. Electrolyte support cells were used to verify this concept, and the effect of the electrochemical hydrogen pump was investigated from the composition of the outlet gas. Electrode support cells using a thin film electrolyte was used to reduce overvoltage. It is demonstrated that the steam reforming reaction and the shift reaction take place in one electrochemical cell. Effective catalyst placement and energy efficiency is discussed.

The increasing price of prescription drugs is an ongoing concern for Medicare and Medicaid, particularly for patients with chronic health conditions who are using multiple medications and patients in these programs taking high-priced brand-name specialty drugs. Shifts in benefit design, including higher deductibles and a movement away from copayments to coinsurance, have increased patient out-of-pocket costs and put pressure on program budgets. In this paper, the American College of Physicians expands on its position paper from 2016 and offers additional recommendations to decrease out-of-pocket costs for patients, enhance the government's purchasing power, and address existing policies that add costs to the health care system.

In this article we argue that the EU suffers from autoimmunity: a self-harming protection strategy. Drawing on Derrida’s political understanding of autoimmunity, we contend that the root of this ma...

Ultrasound is the most commonly used imaging technique for the evaluation of ovarian and other adnexal lesions. The interpretation of sonographic findings is variable because of inconsistency in descriptor terminology used among reporting clinicians. The use of vague terms that are inconsistently applied can lead to significant differences in interpretation and subsequent management strategies. A committee was formed under the direction of the ACR initially to create a standardized lexicon for ovarian lesions with the goal of improving the quality and communication of imaging reports between ultrasound examiners and referring clinicians. The ultimate objective will be to apply the lexicon to a risk stratification classification for consistent follow-up and management in clinical practice. This white paper describes the consensus process in the creation of a standardized lexicon for ovarian and adnexal lesions and the resultant lexicon.

Shrinking paper money is a captivating and memorable demonstration of chemistry in action that can be carried out using minimal equipment and reagents. Paper bills can be shrunk down to ∼25% of their initial surface area by treating them with an aqueous solution of sodium periodate. The cellulose in the paper bill is oxidized to dialdehyde cellulose via the Malaprade reaction, and the resulting change in size of the paper money provides macroscopic evidence of the reaction. The chemical change that occurs in the cellulose can be confirmed by a Tollen’s test.

This position paper is the result of a collaborative approach of several European Specialty Accreditation Boards (ESABs) and, has been stimulated by their current experience in accreditation regarding roles and responsibilities assumed by sponsors of accredited continuing medical education (CME). The suggestions made in this paper aim to preserve the fundamental principle in CME accreditation that the physician in charge of the programme has sole responsibility for the selection of topics, speakers, content and format, as well as mode of presentation, and that sponsors will under no circumstances interfere with this principle. This is considered as a responsibility of an individual physician (or physicians), which cannot be delegated, even in part, to third parties. This responsibility has been extended to include all communication before and after the event. The paper also identifies undecided issues, about which ESABs are committed to elaborate proposals in the future.

This Public Expenditure Review updates previous assessments of the levels and efficiency of health financing in Tajikistan and its consequences for healthcare access and health of the Tajik population. Funding for the public healthcare system which provides almost all healthcare remains far short of levels required to provide a universal basic benefit package. As a result, household out-of-pocket payments account for most healthcare spending in the country, and Tajiks frequently forgo needed care for financial reasons. The underfunding of public healthcare in part results from an overall lack of public revenues. It is, however, exacerbated by the health sector enjoying limited priority, with a health share in total government spending far below internationally recognized targets. Inefficiencies in the spending of the limited public funds further undermine the system’s ability to provide the population with basic healthcare of appropriate quality. Despite efforts in the past two decades to introduce elements of strategic purchasing and direct a higher share of funding towards primary care, public health financing in Tajikistan still largely follows the centrally planned, hospital-focused, and mainly input-financed Semashko model. The result are substantial regional inequalities in per capita government health spending which reflect differences in health facility and health worker densities rather than healthcare need, a continued overemphasis on hospital and specialist care, and an inability of facility managers to take efficiency-oriented staffing decisions. Key recommendation to address these shortcoming are that a substantially higher share of public revenues be allocated to the health sector, that an independent, single payer organization, a fully-fledged capitation mechanism for primary care and elements of strategic purchasing for inpatient care be gradually introduced, and that current benefit packages are revised and extended to achieve more rational and equitable healthcare utilization. Broad consensus building among stakeholders will be essential for the success of such reforms.

The leadership of the American Surgical Association (ASA) appointed a Task Force to objectively address issues related to equity, diversity, and inclusion with the discipline of academic surgery.Surgeons and the discipline of surgery, particularly academic surgery, have a tradition of leadership both in medicine and society. Currently, we are being challenged to harness our innate curiosity, hard work, and perseverance to address the historically significant deficiencies within our field in the areas of diversity, equity, and inclusion.The ASA leadership requested members to volunteer to serve on a Task Force to comprehensively address equity, diversity, and inclusion in academic surgery. Nine work groups reviewed the current literature, performed primary qualitative interviews, and distilled available guidelines and published primary source materials. A work product was created and published on the ASA Website and made available to the public. The full work product was summarized into this White Paper.The ASA has produced a handbook entitled: Ensuring Equity, Diversity, and Inclusion in Academic Surgery, which identifies issues and challenges, and develops a set of solutions and benchmarks to aid the academic surgical community in achieving these goals.Surgery must identify areas for improvement and work iteratively to address and correct past deficiencies. This requires honest and ongoing identification and correction of implicit and explicit biases. Increasing diversity in our departments, residencies, and universities will improve patient care, enhance productivity, augment community connections, and achieve our most fundamental ambition-doing good for our patients.

Background Ankle and foot sprains and fractures are prevalent injuries, which may result in substantial physical and economic consequences for the patient and place a financial burden on the health care system. Therefore, the objectives of this paper are to examine the direct and indirect costs of treating ankle and foot injuries (sprains, dislocations, fractures), as well as to provide an overview of the outcomes of full economic analyses of different treatment strategies. Methods A systematic review was carried out among seven databases to identify English language publications on the health economics of ankle and foot injury treatment published between 1980 and 2014. The direct and indirect costs were abstracted by two independent reviewers. All costs were adjusted for inflation and reported in 2016 US dollars (USD). Results Among 2047 identified studies, 32 were selected for analysis. The direct costs of ankle sprain management ranged from $292 to $2268 per patient (2016 USD), depending on the injury severity and treatment strategy. The direct costs of managing ankle fractures were higher ($1908–$19,555). Foot fracture treatment had similar direct costs ranging from $998 to $21,801. The economic evaluations were conducted from the societal or payer’s perspectives. Conclusion The costs of treating ankle and foot sprains and fractures varied among the studies, mostly due to differences in injury type and study characteristics, which impacted the ability of directly comparing the financial burden of treatment. Nonetheless, the review showed that the costs experienced by the patient and the health care system increased with injury complexity.

Background A robust medical claims review system is crucial for addressing fraud and abuse and ensuring financial viability of health insurance organisations. This paper assesses claims adjustment rate of the paper- and electronic-based claims reviews of the National Health Insurance Scheme (NHIS) in Ghana. Methods The study was a cross-sectional comparative assessment of paper- and electronic-based claims reviews of the NHIS. Medical claims of subscribers for the year, 2014 were requested from the claims directorate and analysed. Proportions of claims adjusted by the paper- and electronic-based claims reviews were determined for each type of healthcare facility. Bivariate analyses were also conducted to test for differences in claims adjustments between healthcare facility types, and between the two claims reviews. Results The electronic-based review made overall adjustment of 17.0% from GHS10.09 million (USD2.64 m) claims cost whilst the paper-based review adjusted 4.9% from a total of GHS57.50 million (USD15.09 m) claims cost received, and the difference was significant (p

The present status of Anaerobic treatment of pulp and paper industry effluents is presented in this chapter. The manufacturers of commercial reactors for waste water treatment and commercial installations are also presented.

The use of extracorporeal membrane oxygenation (ECMO) for severe acute respiratory failure (ARF) in adults is growing rapidly given recent advances in technology, even though there is controversy regarding the evidence justifying its use. Because ECMO is a complex, high-risk, and costly modality, at present it should be conducted in centers with sufficient experience, volume, and expertise to ensure it is used safely. This position paper represents the consensus opinion of an international group of physicians and associated health-care workers who have expertise in therapeutic modalities used in the treatment of patients with severe ARF, with a focus on ECMO. The aim of this paper is to provide physicians, ECMO center directors and coordinators, hospital directors, health-care organizations, and regional, national, and international policy makers a description of the optimal approach to organizing ECMO programs for ARF in adult patients. Importantly, this will help ensure that ECMO is delivered safely and...

Animals frequently compete over limited resources such as food, territories or mating opportunities. Contest behaviour varies based on factors such as the value of the contested resources and the agonistic ability of rivals. Much work on animal contests has examined aggression, but vigilance, or a state of heightened alertness directed towards specific stimuli, may also be an important component of competition in many species. In this study, we measure the relationships among social vigilance, aggression, agonistic ability and resource value during staged contests over nest ownership in Polistes dominula nest-founding wasps. Our results show that both social vigilance and aggression are involved in mediating social risk during contests. Nest owner vigilance towards a rival increased with the time of season, a measure of nest value. Owner vigilance was also positively associated with aggression such that more aggressive owners were more vigilant. During contests, aggression of owners and rivals was influenced by different factors. Owner aggression was positively associated with nest size, another measure of nest value, while rival aggression was unrelated to nest size. Instead, rival aggression was associated with facial patterns that function as signals of agonistic ability; rivals were less aggressive to owners that signalled high agonistic ability than they were to owners that signalled low agonistic ability. The distinct predictors of contest behaviour between owners and rivals indicate that competitive role has a surprisingly strong influence on cues used to inform contest behaviour. Differences may occur because owners and rivals have different information and/or motivation. These results also suggest that social vigilance and aggression may be complementary behaviours that animals use to mitigate social threat.

Aim To describe and discuss clinical strategies for nurses working in partnership with substitute decision-makers for people living with advanced dementia. Background By providing person-centred care to patients living with advanced dementia, nurses are positioned to work in partnership with substitute decision-makers who make healthcare decisions related to advanced care. Because the experience of being substitute decision-makers is complex and stressful, nurses need skillsets for working in partnership with substitute decision-makers. Design In this discursive paper, an innovative framework for working in partnership with substitute decision-makers is proposed. Method Evidence-based findings from a systematic review provided five domain foci for the partnership framework. In each domain, two clinical strategies were discursively proposed. Clinical strategies were hypothesised from research findings and insights from the authors' nursing experiences. Then, topical literature was searched, and findings were used to support the discursively argued strategies. Discussion To deal with complexities and reduce stress for substitute decision-makers, an innovative Nurse-Substitute Decision-Maker Partnership Framework for use in the context of advanced dementia is proposed and discussed. The partnership framework consists of five domains: Building trust, Exploring emotions, Translating quality of life, Encouraging proactivity and Negotiating families. Within these domains, ten strategies to support the practices of clinical nurses to work in partnership with substitute decision-makers are discussed. Relevance to clinical practice In the framework, the ten clinical nursing strategies are designed to provide targeted care to substitute decision-makers in areas that are known to cause complexity and stress to them. The Nurse-Substitute Decision-Maker Partnership Framework has been designed to improve nurse-substitute decision-maker partnerships and reduce the stress experienced by substitute decision-makers as they work through the complexities associated with advanced dementia.

A medical researcher who took a political appointment with the Trump administration while working on a major international meta-analysis of potential covid-19 treatments leaked a preprint version of the research to senior government colleagues last year, documents released in a congressional investigation show.1 Paul Alexander, a former assistant professor at McMaster University in Canada who specialises in health research methods, wrote in an email to Stephen Hahn, commissioner of the Food and Drug Administration (FDA), that the research lent support to a role for hydroxychloroquine. The FDA authorised the antimalarial on an emergency basis last April under pressure from Trump, but revoked this in June, citing the drug’s “known risks” and stating that it was “no longer reasonable to …

The controversy over vaccines, which has recently intensified following the COVID-19 pandemic, provokes heated debates, with both advocates and opponents raising allegations of bias and fraud in re...

This article investigates the effects of economic recessions and changes in local economic conditions on the growth of food-at-home and food-away-from-home sales at the county level and estimates the likely impacts of the COVID-19-induced recession on food sales. On average, we show the recessionary effects of COVID-19 are likely to increase the growth of food-at-home sales by 1 percent and decrease the growth of food-away-from-home sales by 0.9 percent. These results indicate the recessionary effects of COVID-19 on food sales are small compared to the pandemic and public health effects of COVID-19 on food sales.

The Belgian Mental Health Care organisation was substantially reformed (Art 107) in 2010, to orient mental health care towards a reduction of residential hospital care in favour of recovery and reintegration treatment in the community. This reform did not have a specific focus on decreasing gender disparities in mental health care use, even though all newly implemented policies within Belgium are mandated to be subject to gender mainstreaming. However, gender-segregated statistics on (mental) health issues are reported regularly. The monitoring of problematic media use is mainly performed through independent scientific studies. Several destigmatising campaigns have been developed within the Belgian context, but to the best of our knowledge, these have not had a gender focus.

1.1. Cardiovascular disease and dyslipidemia: prevalence and global economic impact Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide, reaching 31% of deaths in 2012 [1]. In particular, atherosclerosis and ischemic heart disease (IHD) are the main causes of premature death in Europe and are responsible for 42% of deaths in women and 38% in men under 75 years old [2]. The global economic impact of CVD is estimated to have been US $906 billion in 2015 and is expected to rise by 22% by 2030 [3]. Cardiovascular diseases also represent the major cause of disability in developed countries. It has been estimated that their growing burden could lead to a global increase in loss of disability-adjusted life years (DALYs), from a loss of 85 million DALYs in 1990 to a loss of ~150 million DALYs in 2020, becoming a major non-psychological cause of lost productivity [4]. Several risk factors contribute to the etiology and development of CVD; they are divided into those modifiable through lifestyle changes or by taking a pharmacologic treatment (e.g. for hypertension, smoking, diabetes mellitus, hypercholesterolemia) and those that are not modifiable (age, male gender, and family history) [5]. Elevated total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) blood concentrations are the major modifiable risk factors for coronary heart disease (CHD), whereas high concentrations of plasma high-density lipoprotein cholesterol (HDL-C) in certain conditions are considered protective [6]. Moreover, LDL-C remains a fundamental CV risk factor (and a main target of therapy) even when statins are largely used in the general population [7]. An examination of the data of 18 053 participants aged ≥ 20 years who participated in the National Health and Nutrition Examination Surveys (NHANES) from 1999 to 2006 showed that the unadjusted prevalence of hypercholesterolemia ranged from 53.2% to 56.1% in United States adults [8]. Differences related to gender and race or ethnicity were observed; in particular, a lower rate of control was found among women than men and lower rates of having a cholesterol check and being told about hypercholesterolemia were reported by African Americans and Mexican Americans than whites [8]. A recent report from the American Heart Association confirmed that in the US only 75.7% of children and 46.6% of adults present targeted TC levels (TC < 170 mg/dl for children and < 200 mg/dl for adults, in untreated individuals) [9]. The pattern is similar in other Western countries [10, 11].

Purpose Plate waste is uneaten food left behind on the plate after a meal. Plate waste – like all food waste – burdens the environment. Plate waste – in contrast to other types of food waste – is absolutely unnecessary and almost entirely preventable. This study aims to synthesize past research on plate waste and outline a future research agenda. Design/methodology/approach Past research into plate waste is discussed, and the need for specific directions of future research is pointed out. A systematics of measures for the prevention of plate waste is offered which uses the following as criteria: the suitability of measures to the hospitality context; and whether the measure has been scientifically proven to be effective. Findings Plate waste research has a very short history. To date, efforts have been focusing on quantifying the extent of the problem. More theoretical work is needed to identify drivers of place waste and develop and experimentally test theory-based practical interventions to reduce the amount of plate waste generated. Originality/value The key contribution of this perspective paper is to synthesize prior work on plate waste and offer a future research agenda.

Organic synthesis allows scientists to construct and modify organic compounds using a continuously growing arsenal of reactions and methodologies [...]

Introduction Increasingly, over the past decade, there has been a global shift in healthcare away from fixed "fee for service" payment mechanisms towards value-based reimbursement models rewarding safety and quality patient outcomes. Curbing the burgeoning costs of healthcare while incentivising higher quality and safer patient care are key drivers of this approach. At face value, this is clearly a worthwhile endeavour. However, there is a lack of conclusive evidence to support the effectiveness of such schemes where they have been introduced internationally. For this reason, Australia has largely been an observer of the shift in payment modalities that are occurring in other countries such as the United States and the United Kingdom. Method This paper presents an overview of current Australian practice in pricing for safety and quality in Healthcare. Recommendations are provided to help infection control professionals prepare for the upcoming introduction of funding reforms aimed at reducing complications acquired in Australian public hospitals. Conclusion The implications for infection control professionals are wide-ranging. This will be a period of significant adjustment for the public health system in Australia.

In July 2010, the new Coalition Government unveiled its plans to make major changes to the English National Health Service (NHS). This paper, which provides a commentary on the NHS White Paper, Equity and Excellence: Liberating the NHS, casts doubt upon the extent to which the proposals will bring about the fundamental reform that the Government intends, not least because both the British public and GP commissioners (who are expected to play a central role in transforming the NHS) appear to have a limited appetite for radical market reform. The paper also identifies a number of unintended risks, including the large transitional costs and organisational turbulence resulting from further NHS reorganisation; and the fact that key aspects of the White Paper proposals could result in significant financial instability. Given the real world limitations to translating a rhetoric of localism and democratic legitimacy into reality and a lack of hard evidence about the benefits of market reform, the Government would be well advised to take a more cautious approach to health policy formulation and implementation and to ensure that any further changes to the NHS are based on evidence, piloting and evaluation.

Purpose: The adoption of electronic medical record (EMR) system is gradually increasing. However, various time-motion studies reveal conflicting data regarding time effectiveness on workflow due to computerization. One of the major issues for physicians is their uncertainty with EMRs' potential impact of time on workflow. A tertiary eye hospital in south India was in the process of implementing an EMR system in their ambulatory care unit. Many of the staff did not have previous computing experience and there were conflicting views on the time effectiveness of the computerized system after implementation. The management was thus interested to know the real time effectiveness of EMR in their hospital. The study compliments existing studies of this type by comparing the time efficiency of documentation time using EMR system with paper documentation in a hospital in a developing country where a transition between paper and EMR documentation was currently in progress. Methods: Ten randomly selected optometrists documented the time they spent during consultation with both paper and EMR documentation. The time spent was documented for a total of 200 records (100 EMR and 100 paper records). The independent-samples t-test and analysis of variance were used to compare the means of the consultation time and calculated documentation time spent between the electronic and paper records. Results: There was no statistically significant difference in the time spent for documentation between electronic and paper records. The mean time spent in documenting electronic records was 0.92min (95% CI -3.06 to 1.14) longer than in paper records. Conclusion: EMR systems can be adopted in eye hospitals without having significant negative impact on duration of consultation and documentation for optometrists. More time-motion studies that include ophthalmologists are however needed in order to get a more complete picture of time impact of the EMR system on clinical workflow in eye hospitals.

In this position paper, the Alliance for Academic Internal Medicine and the American College of Physicians examine the state of graduate medical education (GME) financing in the United States and recent proposals to reform GME funding. They make a series of recommendations to reform the current funding system to better align GME with the needs of the nation's health care workforce. These recommendations include using Medicare GME funds to meet policy goals and to ensure an adequate supply of physicians, a proper specialty mix, and appropriate training sites; spreading the costs of financing GME across the health care system; evaluating the true cost of training a resident and establishing a single per-resident amount; increasing transparency and innovation; and ensuring that primary care residents receive training in well-functioning ambulatory settings that are financially supported for their training roles.

This American College of Physicians position paper, initiated and written by its Health and Public Policy Committee and approved by the Board of Regents on 16 February 2016, reports policy recommendations from the American College of Physicians to address the escalating costs of prescription drugs in the United States. Prescription drugs play an important part in treating and preventing disease. However, the United States often pays more for some prescription drugs than other developed countries, and the high price and increasing costs associated with prescription medication is a major concern for patients, physicians, and payers. Pharmaceutical companies have considerable flexibility in how they price drugs, and the costs that payers and patients see are dependent on how payers are able to negotiate discounts or rebates. Beyond setting list prices are issues of regulatory approval, patents and intellectual property, assessment of value and cost-effectiveness, and health plan drug benefits. These issues are linked, and comprehensive efforts will be needed to affect how drugs are priced in the United States.

Famous for pioneering the oxygenation of nitrous-oxide anesthetics, Chicago surgeon Edmund Andrews trusted the Manhattan-based Colton Dental Association's claim that they had conducted 75,000 nitrous-oxide anesthetics without a single mortality. Those statistics were cited in Andrews' 1870 journal article on anesthetic risks and then, remarkably, advertised on the business cards of dentist James M. Spencer, Jr., of Gouverneur, New York.