Priority setting for pandemic preparedness and response:A comparative analysis of COVID-19 pandemic plans in 12 countries in the Eastern Mediterranean Region

Background: The COVID-19 pandemic has significantly disrupted health systems and exacerbated pre-existing resource gaps in the Eastern Mediterranean Region (WHO-EMRO). Active humanitarian and refugee crises have led to mass population displacement and increased health system fragility, which has implication for equitable priority setting (PS). We examine whether and how PS was included in national COVID-19 pandemic plans within EMRO.Methods: An analysis of COVID-19 pandemic response and preparedness planning documents from a sample of 12/22 countries in WHO-EMRO. We assessed the degree to which documented PS processes adhere to twenty established quality parameters of effective PS.Results: While all reviewed plans addressed some aspect of PS, none included all quality parameters. Yemen’s plan included the highest number (9) of quality parameters, while Egypt’s addressed the lowest (3). Most plans used evidence in their planning processes. While no plans explicitly identify equity as a criterion to guide PS; many identified vulnerable populations - a key component of equitable PS. Despite high concentrations of refugees, migrants, and IDPs in EMRO, only a quarter of the plans identified them as vulnerable.Conclusion: PS setting challenges are exacerbated by conflict and the resulting health system fragmentation. Systematic and quality PS is essential to tackle long-term health implications of COVID-19 for vulnerable populations in this region, and to support effective PS and equitable resource allocation

Uso del conocimiento científico de estudiantes de pregrado de educación diferencial

The objectives of the study were to describe the scientific knowledge of undergraduate students of differential education and to compare with other national studies. We studied 79 students of differential education from a University of Santiago (Chile). Seventy-nine (02 male and 77 female) undergraduate students were selected in a non-probabilistic (intentional) manner in 2017 of the differential education ca- reer at the Universidad Católica Silva Henriquez (UCSH) in Santiago, Chile. The age range ranges from 17 to 27 years. The technique of the survey was used and the instrument used was a questionnaire of the use of scientific knowledge. The results indicate that the use of scientific knowledge of students studying differential education is similar in relation to their counterparts from another university. In addition, the levels reached in the search of information, the transfer of knowledge and the contribution to the knowledge in relation to other professional careers of education sciences are also similar. The results suggest more deeply insightful research skills and attitudes from the initial levels in differential education students, so that in the future they can perform successfully in their professional activities.Los objetivos del estudio fueron describir el conocimiento científico de estudiantes de pregrado de Educación Diferencial y compararlos con otros estudios nacionales. Se estudió a 79 estudiantes de Educación Diferencial de una Universidad de Santiago (Chile). Fueron seleccionados de forma no probabilística (intencionada) 79 (02 hombres y 77 mujeres) estudiantes de pre grado de ingreso año 2017 de la carrera de Educación Diferencial de la Universidad Católica Silva Henríquez (UCSH) de Santiago de Chile. El rango de edad oscila entre 17 a 27 años. Se utilizó la técnica de la encuesta y el instrumento utilizado fue un cuestionario del uso del conocimiento científico. Los resultados indican que el uso del conocimiento científico de los alumnos que estudian Educación Diferencial es similar en relación a sus contrapartes de otra universidad. Además, los niveles alcanzados en la búsqueda de información, la transferencia del conocimiento y la contribución al conocimiento en relación a otras carreras profesionales de ciencias de la educación, también son similares. Los resultados sugieren insentivar con mayor profundidad las habilidades y actitudes investigativas desde los niveles iniciales en los estudiante de Educación Diferencial, para que en el futuro puedan desempeñarse con éxito en sus actividades profesionales

A hypoperfusion context may aid to interpret hyperlactatemia in sepsis-3 septic shock patients: a proof-of-concept study

__Background:__ Persistent hyperlactatemia is particularly difficult to interpret in septic shock. Besides hypoperfusion, adrenergic-driven lactate production and impaired lactate clearance are important contributors. However, clinical recognition of different sources of hyperlactatemia is unfortunately not a common practice and patients are treated with the same strategy despite the risk of over-resuscitation in some. Indeed, pursuing additional resuscitation in non-hypoperfusion-related cases might lead to the toxicity of fluid overload and vasoactive drugs. We hypothesized that two different clinical patterns can be recognized in septic shock patients through a multimodal perfusion monitoring. Hyperlactatemic patients with a hypoperfusion context probably represent a more severe acute circulatory dysfunction, and the absence of a hypoperfusion context is eventually associated with a good outcome. We performed a retrospective analysis of a database of septic shock patients with persistent hyperlactatemia after initial resuscitation. __Results:__ We defined hypoperfusion context by the presence of a ScvO2 < 70%, or a P(cv-a)CO2 ≥6 mmHg, or a CRT ≥4 s together with hyperlactatemia. Ninety patients were included, of whom seventy exhibited a hypoperfusion-related pattern and 20 did not. Although lactate values were comparable at baseline (4.8 ± 2.8 vs. 4.7 ± 3.7 mmol/L), patients with a hypoperfusion context exhibited a more severe circulatory dysfunction with higher vasopressor requirements, and a trend to longer mechanical ventilation days, ICU stay, and more rescue therapies. Only one of the 20 hyperlactatemic patients without a hypoperfusion context died (5%) compared to 11 of the 70 with hypoperfusion-related hyperlactatemia (16%). __Conclusions:__ Two different clinical patterns among hyperlactatemic septic shock patients may be identified according to hypoperfusion context. Patients with hyperlactatemia plus low ScvO2, or high P(cv-a)CO2, or high CRT values exhibited a more severe circulatory dysfunction. This provides a starting point to launch further prospective studies to confirm if this approach can lead to a more selective resuscitation strategy

Ethical allocation of scarce health care resources in the context of the COVID-19 crisis

The current COVID-19 pandemic has the potential to overwhelm the capacity of hospitals and Intensive Care Units in Chile and Latin America. Thus local authorities have an ethical obligation to be prepared by implementing pertinent measures to prevent a situation of rationing of scarce healthcare resources, and by defining ethically acceptable and socially legitimate criteria for the allocation of these resources. This paper responds to recent ethical guidelines issued by a Chilean academic institution and discusses the main moral principles for the ethical foundations of criteria for rationing during the present crisis. It argues that under exceptional circumstances such as the current pandemic, the traditional patient-centered morality of medicine needs to be balanced with ethical principles formulated from a public health perspective, including the principles of social utility, social justice and equity, among others. The paper concludes with some recommendations regarding how to reach an agreement about rationing criteria and about their implementation in clinical practice

Do honeybees have concepts?

Can animals think? In this paper I address the proposal that many animals, including insects such as honeybees, have genuine thoughts. I consider one prominent version of this view (Carruthers 2004; 2006) that claims that honeybees can represent and process information about their environments in a way that satisfies the main hallmarks of human conceptual thought. I shall argue, however, that this view fails to provide convincing grounds for accepting that animals possess concepts. More precisely, I suggest that two important aspects of conceptual thought, viz., concept individuation and the generality constraint, are not satisfied