Objective:
We describe a structured approach to developing a standardized curriculum for surgical trainees in East, Central, and Southern Africa (ECSA).
Summary Background Data:
Surgical education is ...essential to closing the surgical access gap in ECSA. Given its importance for surgical education, the development of a standardized curriculum was deemed necessary.
Methods:
We utilized Kern’s 6-step approach to curriculum development to design an online, modular, flipped-classroom surgical curriculum. Steps included global and targeted needs assessments, determination of goals and objectives, the establishment of educational strategies, implementation, and evaluation.
Results:
Global needs assessment identified the development of a standardized curriculum as an essential next step in the growth of surgical education programs in ECSA. Targeted needs assessment of stakeholders found medical knowledge challenges, regulatory requirements, language variance, content gaps, expense and availability of resources, faculty numbers, and content delivery method to be factors to inform curriculum design. Goals emerged to increase uniformity and consistency in training, create contextually relevant material, incorporate best educational practices, reduce faculty burden, and ease content delivery and updates. Educational strategies centered on developing an online, flipped-classroom, modular curriculum emphasizing textual simplicity, multimedia components, and incorporation of active learning strategies. The implementation process involved establishing thematic topics and subtopics, the content of which was authored by regional surgeon educators and edited by content experts. Evaluation was performed by recording participation, soliciting user feedback, and evaluating scores on a certification examination.
Conclusions:
We present the systematic design of a large-scale, context-relevant, data-driven surgical curriculum for the ECSA region.
NP
-B*07:02-specific CD8
T cell responses are considered among the most dominant in SARS-CoV-2-infected individuals. We found strong association of this response with mild disease. Analysis of NP
...-B*07:02-specific T cell clones and single-cell sequencing were performed concurrently, with functional avidity and antiviral efficacy assessed using an in vitro SARS-CoV-2 infection system, and were correlated with T cell receptor usage, transcriptome signature and disease severity (acute n = 77, convalescent n = 52). We demonstrated a beneficial association of NP
-B*07:02-specific T cells in COVID-19 disease progression, linked with expansion of T cell precursors, high functional avidity and antiviral effector function. Broad immune memory pools were narrowed postinfection but NP
-B*07:02-specific T cells were maintained 6 months after infection with preserved antiviral efficacy to the SARS-CoV-2 Victoria strain, as well as Alpha, Beta, Gamma and Delta variants. Our data show that NP
-B*07:02-specific T cell responses associate with mild disease and high antiviral efficacy, pointing to inclusion for future vaccine design.
Global temperature is a fundamental climate metric highly correlated with sea level, which implies that keeping shorelines near their present location requires keeping global temperature within or ...close to its preindustrial Holocene range. However, global temperature excluding short-term variability now exceeds +1 °C relative to the 1880-1920 mean and annual 2016 global temperature was almost +1.3 °C. We show that global temperature has risen well out of the Holocene range and Earth is now as warm as it was during the prior (Eemian) interglacial period, when sea level reached 6-9 m higher than today. Further, Earth is out of energy balance with present atmospheric composition, implying that more warming is in the pipeline, and we show that the growth rate of greenhouse gas climate forcing has accelerated markedly in the past decade. The rapidity of ice sheet and sea level response to global temperature is difficult to predict, but is dependent on the magnitude of warming. Targets for limiting global warming thus, at minimum, should aim to avoid leaving global temperature at Eemian or higher levels for centuries. Such targets now require negative emissions, i.e., extraction of CO.sub.2 from the air. If phasedown of fossil fuel emissions begins soon, improved agricultural and forestry practices, including reforestation and steps to improve soil fertility and increase its carbon content, may provide much of the necessary CO.sub.2 extraction. In that case, the magnitude and duration of global temperature excursion above the natural range of the current interglacial (Holocene) could be limited and irreversible climate impacts could be minimized. In contrast, continued high fossil fuel emissions today place a burden on young people to undertake massive technological CO.sub.2 extraction if they are to limit climate change and its consequences. Proposed methods of extraction such as bioenergy with carbon capture and storage (BECCS) or air capture of CO.sub.2 have minimal estimated costs of USD 89-535 trillion this century and also have large risks and uncertain feasibility. Continued high fossil fuel emissions unarguably sentences young people to either a massive, implausible cleanup or growing deleterious climate impacts or both.
Objectives
Shortness of breath is a common reason for ED attendance. This international study aims to describe the epidemiology of dyspnoea presenting to EDs in the South East Asia‐Pacific region, to ...compare disease patterns across regions, to understand how conditions are investigated and treated, and to assess quality of care.
Methods/Design
This is a prospective, interrupted time series cohort study conducted in EDs in Australia, New Zealand, Singapore, Hong Kong and Malaysia of consecutive adult patients presenting to the ED with dyspnoea as a main symptom. Data were collected over three 72 h periods in May, August and October 2014 (autumn, winter and spring), and included demographics, comorbidities, mode of arrival, usual medications, pre‐hospital treatment, initial assessment, ED investigations, treatment in the ED, ED diagnosis, disposition from ED, in‐hospital outcome and final hospital diagnosis. The primary outcomes of interest are the epidemiology and outcome of patients presenting to ED with dyspnoea. Secondary outcomes of interest are seasonal and geographic comparisons of diagnoses and outcomes, disease‐specific descriptions of epidemiology, investigation, treatment and disposition, and compliance with treatment guidelines.
Discussion
This novel study will explore dyspnoea from the viewpoint of the patient's symptom (shortness of breath) rather than that of a single disease. The results will provide robust data about the epidemiology, investigation, treatment and disposition of this diverse patient group. The obtained data also have the potential to inform service planning and to quantify the proportion of patients with mixed cardiac and respiratory disease.
Tidal Marsh Restoration Roman, Charles T; Burdick, David M; Falk, Donald A
2012, 2014, 2012-08-07
eBook
Many coastal tidal marshes have been significantly degraded by roadways and other projects that restrict tidal flows, limiting their ability to provide vital ecosystem services including support of ...fish and wildlife populations, flood protection, water quality maintenance, and open space.Tidal Marsh Restoration provides the scientific foundation and practical guidance necessary for coastal zone stewards to initiate salt marsh tidal restoration programs. The book compiles, synthesizes, and interprets the current state of knowledge on the science and practice of salt marsh restoration, bringing together leaders across a range of disciplines in the sciences (hydrology, soils, vegetation, zoology), engineering (hydraulics, modeling), and public policy, with coastal managers who offer an abundance of practical insight and guidance on the development of programs.The work presents in-depth information from New England and Atlantic Canada, where the practice of restoring tidal flow to salt marshes has been ongoing for decades, and shows how that experience can inform restoration efforts around the world. Students and researchers involved in restoration science will find the technical syntheses, presentation of new concepts, and identification of research needs to be especially useful as they formulate research and monitoring questions, and interpret research findings.Tidal Marsh Restoration is an essential work for managers, planners, regulators, environmental and engineering consultants, and others engaged in planning, designing, and implementing projects or programs aimed at restoring tidal flow to tide-restricted or diked salt marshes.
Abstract
Arctic primary production is sensitive to reductions in sea ice cover, and will likely increase into the future. Whether this increased primary production (PP) will translate into increased ...export of particulate organic carbon (POC) is currently unclear. Here we report on the POC export efficiency during summer 2012 in the Atlantic sector of the Arctic Ocean. We coupled 234‐thorium based estimates of the export flux of POC to onboard incubation‐based estimates of PP. Export efficiency (defined as the fraction of PP that is exported below 100 m depth:
ThE
‐ratio) showed large variability (0.09 ± 0.19–1.3 ± 0.3). The highest
ThE
‐ratio (1.3 ± 0.3) was recorded in a mono‐specific bloom of
Phaeocystis pouchetii
located in the ice edge. Blooming diatom dominated areas also had high
ThE
‐ratios (0.1 ± 0.1–0.5 ± 0.2), while mixed and/or prebloom communities showed lower
ThE
‐ratios (0.10 ± 0.03–0.19 ± 0.05). Furthermore, using oxygen saturation, bacterial abundance, bacterial production, and zooplankton oxygen demand, we also investigated spatial variability in the degree to which this sinking material may be remineralized in the upper mesopelagic (<300 m). Our results suggest that blooming diatoms and
P. pouchetii
can export a significant fraction of their biomass below the surface layer (100 m) in the open Arctic Ocean. Also, we show evidence that the material sinking from a
P. pouchetii
bloom may be remineralized (>100 m) at a similar rate as the material sinking from diatom blooms in the upper mesopelagic, contrary to previous findings.
Key Points:
Arctic export efficiency displays large variability
Blooming diatoms and
Phaeocystis
sp. have the highest export efficiency
More work is needed on upper mesopelagic remineralization in the Arctic
Macrobicycle 12 has been synthesized and its binding properties with a range of N-acetyl amino acid carboxylates (as tetrabutylammonium salts) have been studied. While the binding results showed ...little selectivity for the various substrates investigated, detailed NMR studies have revealed that d-amino acid substrates bind predominantly on the outside of the macrobicycle cavity by a strong carboxylate−thiourea interaction, whereas l-amino acid substrates bind predominantly on the inside of the cavity also establishing a strong carboxylate−thiourea interaction but with the acetyl amide in a cis configuration. Molecular modeling studies suggest that the energetic penalty associated with adopting a cis amide configuration in the host−guest complex is compensated by intermolecular hydrogen bonds between the cis amide and the rim of the macrobicycle.
The application of a 1 mm TXI (1H/13C/15N) microlitre NMR probe with z-gradient for metabolic profiling of biofluids is described. The probe was used to provide spectral profiles for rat blood plasma ...using only approximately 2 microl of fluid with a range of solvent suppression techniques. Using a similar amount of fluid, spectra were obtained from rat and mouse cerebrospinal fluid, demonstrating that the probe could be used to profile rodents metabolically via biofluids previously inaccessible to NMR analysis without the need for termination.
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