International Partnerships in Health Education: Adapting E-Learning Models for Conflict-Affected Myanmar

Background: In the wake of Myanmar's 2021 military coup, the University of Parma, in partnership with Myanmar and Brazilian institutions, developed an asynchronous e-learning program to sustain healthcare education amid severe disruptions. The program aimed to address urgent training needs in emergency medicine, public health management, and mental health, aligning with Sustainable Development Goals. Methods: An educational needs assessment involving 298 surveys and 10 interviews identified training priorities. Based on these findings, a four-module e-learning course was created, covering basic life support, trauma care, pediatric emergencies, and psychological assistance. The course utilized prerecorded high-fidelity telesimulations with multilingual support to ensure accessibility. Evaluation included participant satisfaction using the MSSE questionnaire and knowledge acquisition through post-module quizzes. Results: Over 750 students participated, with significant knowledge acquisition observed-60% scored 8 or higher across all modules. The MSSE questionnaire, completed by 152 students, revealed high satisfaction, with 88% agreeing that the course enhanced clinical reasoning, decision-making, and self-reflection Conclusions: This program demonstrates the value of international partnerships and e-learning in sustaining medical education during crises. High student engagement and strong learning outcomes affirm its efficacy. Future iterations will aim to improve completion rates, refine feedback mechanisms, and expand accessibility. This scalable model offers a blueprint for addressing healthcare training needs in conflict-affected and resource-limited settings, contributing to global health resilience and the achievement of Universal Health Coverage

Interobserver agreement in dysplasia grading: toward an enhanced gold standard for clinical pathology trials

Objective: Interobserver agreement in the context of oral epithelial dysplasia (OED) grading has been notoriously unreliable and can impose barriers for developing new molecular markers and diagnostic technologies. This paper aimed to report the details of a 3-stage histopathology review and adjudication process with the goal of achieving a consensus histopathologic diagnosis of each biopsy. Study Design: Two adjacent serial histologic sections of oral lesions from 846 patients were independently scored by 2 different pathologists from a pool of 4. In instances where the original 2 pathologists disagreed, a third, independent adjudicating pathologist conducted a review of both sections. If a majority agreement was not achieved, the third stage involved a face-to-face consensus review. Results: Individual pathologist pair κ values ranged from 0.251 to 0.706 (fair-good) before the 3-stage review process. During the initial review phase, the 2 pathologists agreed on a diagnosis for 69.9% of the cases. After the adjudication review by a third pathologist, an additional 22.8% of cases were given a consensus diagnosis (agreement of 2 out of 3 pathologists). After the face-to-face review, the remaining 7.3% of cases had a consensus diagnosis. Conclusions: The use of the defined protocol resulted in a substantial increase (30%) in diagnostic agreement and has the potential to improve the level of agreement for establishing gold standards for studies based on histopathologic diagnosis

Traffic Optimization at Junctions to Improve Vehicular Flows

The aim of this work is to improve urban traffic viability through an appropriate choice of yielding and stop signs or red and green phases for traffic lights in junctions with two entering and one exiting roads (junctions of 2×1 type). We consider a macroscopic fluid-dynamic model able to capture the traffic evolution. We analyze different functionals measuring networks performance in terms of average velocity, average traveling time, total flux, density, stop and go waves, average traveling time, weighted with the number of cars moving on roads, and kinetic energy. Right of way parameters which optimize the latter two functionals are obtained. Simulations of simple junctions of 2×1type have been used to test the correctness of the analytical results. Then, global performance of optimization procedures has been investigated on Re di Roma Square, in Italy. In particular, we discuss cases in which the functionals are optimized locally at each junction for different values of right of way parameters. We show that for the chosen initial data the only algorithm for the maximization of velocity assures globally the best performance for the network, also in terms of average traveling times and kinetic energy

Control of IBMIR in Neonatal Porcine Islet Xenotransplantation in Baboons

The instant blood-mediated inflammatory reaction (IBMIR) is a major obstacle to the engraftment of intraportal pig islet xenografts in primates. Higher expression of the galactose-α1,3-galactose (αGal) xenoantigen on neonatal islet cell clusters (NICC) than on adult pig islets may provoke a stronger reaction, but this has not been tested in the baboon model. Here, we report that WT pig NICC xenografts triggered profound IBMIR in baboons, with intravascular clotting and graft destruction occurring within hours, which was not prevented by anti-thrombin treatment. In contrast, IBMIR was minimal when recipients were immunosuppressed with a clinically relevant protocol and transplanted with NICC from αGal-deficient pigs transgenic for the human complement regulators CD55 and CD59. These genetically modified (GM) NICC were less susceptible to humoral injury in vitro than WT NICC, inducing significantly less complement activation and thrombin generation when incubated with baboon platelet-poor plasma. Recipients of GM NICC developed a variable anti-pig antibody response, and examination of the grafts 1 month after transplant revealed significant cell-mediated rejection, although scattered insulin-positive cells were still present. Our results indicate that IBMIR can be attenuated in this model, but long-term graft survival may require more effective immunosuppression or further donor genetic modification

‘Cytology-on-a-chip’ based sensors for monitoring of potentially malignant oral lesions

Despite significant advances in surgical procedures and treatment, long-term prognosis for patients with oral cancer remains poor, with survival rates among the lowest of major cancers. Better methods are desperately needed to identify potential malignancies early when treatments are more effective. Objective To develop robust classification models from cytology-on-a-chip measurements that mirror diagnostic performance of gold standard approach involving tissue biopsy. Materials and methods Measurements were recorded from 714 prospectively recruited patients with suspicious lesions across 6 diagnostic categories (each confirmed by tissue biopsy -histopathology) using a powerful new ‘cytology-on-a-chip’ approach capable of executing high content analysis at a single cell level. Over 200 cellular features related to biomarker expression, nuclear parameters and cellular morphology were recorded per cell. By cataloging an average of 2000 cells per patient, these efforts resulted in nearly 13 million indexed objects. Results Binary “low-risk”/“high-risk” models yielded AUC values of 0.88 and 0.84 for training and validation models, respectively, with an accompanying difference in sensitivity + specificity of 6.2%. In terms of accuracy, this model accurately predicted the correct diagnosis approximately 70% of the time, compared to the 69% initial agreement rate of the pool of expert pathologists. Key parameters identified in these models included cell circularity, Ki67 and EGFR expression, nuclear-cytoplasmic ratio, nuclear area, and cell area. Conclusions This chip-based approach yields objective data that can be leveraged for diagnosis and management of patients with PMOL as well as uncovering new molecular-level insights behind cytological differences across the OED spectrum

Gender and sex bias in prevention and clinical treatment of women's chronic pain: hypotheses of a curriculum development

This discursive paper focuses on undergraduate medical education's role in tackling gender bias in clinical practice, specifically preventing and managing from a non-biomedical perspective chronic pain in women. A preliminary web search of medical schools' curricula was performed to identify programs content related to gender bias in pain management. The web search included 10 universities' websites selected from the top 10 rankings QS Universities Rankings 2022 for medical schools. Additionally, a questionnaire was sent to all deans of the selected academic institutions to explore the curriculum content further. The web search, and the lack of response from the deans, highlighted that relevant curriculum components on gender bias and chronic pain needed to be implemented. Therefore, this paper introduces an innovative curriculum development approach designed by the multi-professional research team to be implemented in medical school programs. This novel educational strategy could also cross-contaminate other healthcare practitioners' university programs and, thus, stimulate an interprofessional debate into fostering inclusiveness and equal opportunities in health

Some new results on a Lavrentieff phenomenon for problems of homogenization with constraints on the gradient

In this paper we analyze, in the context of a Lavrentieff phenomenon, the process of homogenization for Dirichlet problems

Effectiveness of expressive writing protocol in palliative care healthworkers: A quantitative study

Background and aim of the work: Palliative Care professionals are exposed to intense emotional envi-ronment. This puts them at risk for Compassion Fatigue and Burnout. The protective factors that can counter their onset are Compassion Satisfaction, Organizational Commitment and Resilience. Expressive Writing is a valid tool for adapting to traumatic events and enhancing psychological well-being. Aim of this study is to evaluate the effect of the Expressive Writing in Palliative Care professionals on Compassion Satisfaction, Organizational Commitment, Resilience, Compassion Fatigue and perceived distress. Methods: Prospective experimental study with experimental/control groups and pre/post measurements. 50 Palliative Care professionals were recruited in Northern and Central Italy. Participants filled: Organizational Commitment Questionnaire; ProQol-revision III; Resilience Scale for Adults; Impact of Event-Scale Revised; Emotion Thermometer; ad hoc questionnaire for the evaluation of protocol usefulness. Results: Wilcoxon test demon-strated change in Continuative Commitment (Z =-3.357, p = .001), anger (Z =-2.214, p = .027), sleep (Z =-2.268, p = .023), help (Z =-2.184, p = .029), intrusiveness (Z =-2.469, p = .014), hyperarousal (Z =-2.717, p = .007), and total IES (Z =-2.456, p =, 014). Mann Whitney test showed a significantly lower score on post-test Intrusiveness in the experimental group (U = 202, p = .038). Conclusions: The Expressive Writing intervention was effective in improving organizational and emotional variables. Expressive Writing supports healthcare professionals in relieving the burden of traumatic episodes, ordering associated thoughts and emo-tions, and implementing a process of deep comprehension

Autophagic degradation of farnesylated prelamin A as a therapeutic approach to lamin-linked progeria

Farnesylated prelamin A is a processing intermediate produced in the lamin A maturation pathway. Accumulation of a truncated farnesylated prelamin A form, called progerin, is a hallmark of the severe premature ageing syndrome, Hutchinson-Gilford progeria. Progerin elicits toxic effects in cells, leading to chromatin damage and cellular senescence and ultimately causes skin and endothelial defects, bone resorption, lipodystrophy and accelerated ageing. Knowledge of the mechanism underlying prelamin A turnover is critical for the development of clinically effective protein inhibitors that can avoid accumulation to toxic levels without impairing lamin A/C expression, which is essential for normal biological functions. Little is known about specific molecules that may target farnesylated prelamin A to elicit protein degradation. Here, we report the discovery of rapamycin as a novel inhibitor of progerin, which dramatically and selectively decreases protein levels through a mechanism involving autophagic degradation. Rapamycin treatment of progeria cells lowers progerin, as well as wild-type prelamin A levels, and rescues the chromatin phenotype of cultured fibroblasts, including histone methylation status and BAF and LAP2α distribution patterns. Importantly, rapamycin treatment does not affect lamin C protein levels, but increases the relative expression of the prelamin A endoprotease ZMPSTE24. Thus, rapamycin, an antibiotic belonging to the class of macrolides, previously found to increase longevity in mouse models, can serve as a therapeutic tool, to eliminate progerin, avoid farnesylated prelamin A accumulation, and restore chromatin dynamics in progeroid laminopathies