Global Perspectives on Task Shifting and Task Sharing in Neurosurgery.

BACKGROUND: Neurosurgical task shifting and task sharing (TS/S), delegating clinical care to non-neurosurgeons, is ongoing in many hospital systems in which neurosurgeons are scarce. Although TS/S can increase access to treatment, it remains highly controversial. This survey investigated perceptions of neurosurgical TS/S to elucidate whether it is a permissible temporary solution to the global workforce deficit. METHODS: The survey was distributed to a convenience sample of individuals providing neurosurgical care. A digital survey link was distributed through electronic mailing lists of continental neurosurgical societies and various collectives, conference announcements, and social media platforms (July 2018-January 2019). Data were analyzed by descriptive statistics and univariate regression of Likert Scale scores. RESULTS: Survey respondents represented 105 of 194 World Health Organization member countries (54.1%; 391 respondents, 162 from high-income countries and 229 from low- and middle-income countries [LMICs]). The most agreed on statement was that task sharing is preferred to task shifting. There was broad consensus that both task shifting and task sharing should require competency-based evaluation, standardized training endorsed by governing organizations, and maintenance of certification. When perspectives were stratified by income class, LMICs were significantly more likely to agree that task shifting is professionally disruptive to traditional training, task sharing should be a priority where human resources are scarce, and to call for additional TS/S regulation, such as certification and formal consultation with a neurosurgeon (in person or electronic/telemedicine). CONCLUSIONS: Both LMIC and high-income countries agreed that task sharing should be prioritized over task shifting and that additional recommendations and regulations could enhance care. These data invite future discussions on policy and training programs

Effect of Peat Addition on Sorption and Leaching of Triazole Fungicides in Oran Soils

In this paper, the authors treat the impact of peat amendment on sorption and leaching of fungicides penconazole and flusilazole in two Algerian topsoil samples (Misserghine and Es-Senia). The batch equilibration technique was applied for adsorption experiments, and leaching was tested through soil column simulated experiments under laboratory conditions. Adsorption data fitted well to the Freundlich and linear models, showing the higher adsorption capacity of the Es-Senia soil for both fungicides, the order of sorption being flusilazole > penconazole. Organic amendments increased the adsorption of both fungicides especially for the soil with the lower organic matter (OM) content, obtaining a good correlation of this parameter with Kf, thus implying that OM is the principal soil parameter governing fungicides adsorption. Results of soil column experiments indicated that peat amendment decreased leaching of both pesticides in the soils studied. So, the use of organic addition might be an effective management practice for controlling potential pollution of penconazole and/or flusilazole to the environment