Haitian State Hospital Orthopedic Grand Rounds Series: A Virtual Curriculum to Address Global Surgery Needs

Background: Orthopedic Relief Services International (ORSI), in partnership with the Foundation for Orthopedic Trauma and the department of Orthopedic Surgery of La Paix University Hospital in Haiti, has developed a year-round Orthopedic Grand Round series. This series is moderated by Haitian faculty, features presentations by American orthopedic surgeons, and is broadcast to major state hospitals in Haiti for residents and attendings. Objective: To introduce clinical concepts and increase knowledge in an area that is medically underserved, especially in the field of orthopedics, through lectures that tailor to the educational needs of Haiti. Methods: Topics for lecture series are requested by Haitian attending orthopedic surgeons and residents in collaboration with American orthopedic surgeons to meet the educational needs of the residents in Haiti. These lectures reflect the case mix typically seen at state hospitals in Haiti and consider the infrastructural capacity of participating centers. Grand rounds are held an average of twice per month for an hour each, encompassing an educational lesson followed by an open forum for questions and case discussion. Feedback is taken from Haitian residents to ensure the sessions are beneficial to their learning. Findings and Conclusions: To date 95 sessions hosted by 32 lecturers have been completed over Zoom between the US and Haiti. The fourth year of the lecture series is currently ongoing with an expansion of topics. In an underserved medical area such as Haiti, programs that educate local surgeons are crucial to continuing the growth and development of the medical community. Programs like this have the potential to contribute to the educational infrastructure of countries in need, regardless of the specialty. The model of this program can be used to produce similar curricula in various specialties and areas around the world

Glutamine synthetase activity fuels nucleotide biosynthesis and supports growth of glutamine-restriced glioblastoma

L-Glutamine (Gln) functions physiologically to balance the carbon and nitrogen requirements of tissues. It has been proposed that in cancer cells undergoing aerobic glycolysis, accelerated anabolism is sustained by Gln-derived carbons, which replenish the tricarboxylic acid (TCA) cycle (anaplerosis). However, it is shown here that in glioblastoma (GBM) cells, almost half of the Gln-derived glutamate (Glu) is secreted and does not enter the TCA cycle, and that inhibiting glutaminolysis does not affect cell proliferation. Moreover, Gln-starved cells are not rescued by TCA cycle replenishment. Instead, the conversion of Glu to Gln by glutamine synthetase (GS; cataplerosis) confers Gln prototrophy, and fuels de novo purine biosynthesis. In both orthotopic GBM models and in patients, (13)C-glucose tracing showed that GS produces Gln from TCA-cycle-derived carbons. Finally, the Gln required for the growth of GBM tumours is contributed only marginally by the circulation, and is mainly either autonomously synthesized by GS-positive glioma cells, or supplied by astrocytes

Potential climatic transitions with profound impact on Europe

We discuss potential transitions of six climatic subsystems with large-scale impact on Europe, sometimes denoted as tipping elements. These are the ice sheets on Greenland and West Antarctica, the Atlantic thermohaline circulation, Arctic sea ice, Alpine glaciers and northern hemisphere stratospheric ozone. Each system is represented by co-authors actively publishing in the corresponding field. For each subsystem we summarize the mechanism of a potential transition in a warmer climate along with its impact on Europe and assess the likelihood for such a transition based on published scientific literature. As a summary, the ‘tipping’ potential for each system is provided as a function of global mean temperature increase which required some subjective interpretation of scientific facts by the authors and should be considered as a snapshot of our current understanding. <br/

Need for recovery amongst emergency physicians in the UK and Ireland: A cross-sectional survey

OBJECTIVES: To determine the need for recovery (NFR) among emergency physicians and to identify demographic and occupational characteristics associated with higher NFR scores. DESIGN: Cross-sectional electronic survey. SETTING: Emergency departments (EDs) (n=112) in the UK and Ireland. PARTICIPANTS: Emergency physicians, defined as any registered physician working principally within the ED, responding between June and July 2019. MAIN OUTCOME MEASURE: NFR Scale, an 11-item self-administered questionnaire that assesses how work demands affect intershift recovery. RESULTS: The median NFR Score for all 4247 eligible, consented participants with a valid NFR Score was 70.0 (95% CI: 65.5 to 74.5), with an IQR of 45.5-90.0. A linear regression model indicated statistically significant associations between gender, health conditions, type of ED, clinical grade, access to annual and study leave, and time spent working out-of-hours. Groups including male physicians, consultants, general practitioners (GPs) within the ED, those working in paediatric EDs and those with no long-term health condition or disability had a lower NFR Score. After adjusting for these characteristics, the NFR Score increased by 3.7 (95% CI: 0.3 to 7.1) and 6.43 (95% CI: 2.0 to 10.8) for those with difficulty accessing annual and study leave, respectively. Increased percentage of out-of-hours work increased NFR Score almost linearly: 26%-50% out-of-hours work=5.7 (95% CI: 3.1 to 8.4); 51%-75% out-of-hours work=10.3 (95% CI: 7.6 to 13.0); 76%-100% out-of-hours work=14.5 (95% CI: 11.0 to 17.9). CONCLUSION: Higher NFR scores were observed among emergency physicians than reported in any other profession or population to date. While out-of-hours working is unavoidable, the linear relationship observed suggests that any reduction may result in NFR improvement. Evidence-based strategies to improve well-being such as proportional out-of-hours working and improved access to annual and study leave should be carefully considered and implemented where feasible

Exploring the relationship between working from home, mental and physical health and wellbeing: a systematic review

Background Understanding the impact of working from home on health and wellbeing is of great interest to employers and employees alike, with a strong need for up-to-date guidance. The aim of this systematic review was to identify, appraise and synthesise existing research evidence that explores the impact of home working on health and wellbeing outcomes for working people and health inequalities in the population. Methods We conducted a systematic review of qualitative, quantitative and observational studies. We searched databases, reference lists and UK grey literature and completed citation searching of included papers. We extracted and tabulated key data from the included papers and synthesised narratively. Factors associated with the health and wellbeing of people working at home reported in the literature were displayed by constructing mind maps of each individual factor which had been identified. The findings were combined with an a priori model to develop a final model, which was validated in consultation with stakeholders. Results Of 96 studies which were found to meet the inclusion criteria for the review, 30 studies were published before the COVID-19 pandemic and a further 66 were published during the pandemic. The quality of evidence was limited by the study designs employed by the authors, with the majority of studies being cross-sectional surveys (n = 59). For the most part, for studies which collected quantitative data, measures were self-reported. The largest volume of evidence identified consisted of studies conducted during the COVID-19 pandemic which looked at factors which influence the relationship between working from home and measures relating to mental health and wellbeing. Fifteen studies which considered the potential for working at home to have different effects for different subgroups suggested that working at home may have more negative consequences during the COVID-19 pandemic for women and in particular, mothers. There was very little evidence on age (two studies), ethnicity (one study), education or income (two studies) in terms of moderating home working effects, and very limited evidence from before the COVID-19 pandemic. The concept of enforced working from home and having ‘no choice’ was reported in only one paper prior to the pandemic and two papers reporting on working from home as a result of COVID-19. However, the concept of lack of choice around working from home was implicit in much of the literature – even though it was not directly measured. There were no clear patterns of wellbeing measures which changed from positive to negative association (or vice versa) during the pandemic. Limitations The quality of the evidence base was very much limited by study designs, particularly for studies published during the COVID-19 pandemic, with the majority of studies consisting of data collected by cross-sectional surveys (often online). Due to the rapidly expanding nature of the evidence on this topic, it is possible that new studies were published after the final citation searches were conducted. Discussion The evidence base for the factors which influence the relationship between home working and health-related outcomes has expanded significantly as a result of the need for those whose work could be done from home to work at home during the COVID-19 pandemic. Our findings suggest that there are factors relating to the external context, the role of employers and the circumstances of the employee which contribute to determining whether someone works at home and what the associated impacts on health and wellbeing may be. Learning from the COVID-19 lockdown experience will be important to inform future policy on home and hybrid working. Future work There is a need for better-quality studies of the health impact of home working, in particularly studies which recruit a range of participants who are representative of the working population and which are designed to minimise sampling/recruitment biases and response biases. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (project reference 18/93 PHR Public Health Review Team) and will be published in full in Public Health Research; Vol. 11, No. 4. See the NIHR Journals Library website for further project information. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Study registration This study is registered as PROSPERO 2021 CRD42021253474. Plain language summary Introduction Working from home is becoming more common and has increased due to the COVID-19 pandemic. However, the impact of working at home on the health of home workers and the general population remains unclear. Methods We looked for research which had been undertaken to help to understand the impact of home working on people’s health. One researcher summarised the findings of each paper in tables, and these were checked by a second researcher. These were then drawn together into a final diagram to summarise the findings of all the relevant studies. Results We found 96 papers and reports: 30 published before the COVID-19 pandemic and 66 published during the pandemic. This shows that the number of studies in this area has increased significantly as a result of home working due to COVID-19 lockdowns. The largest volume of studies we found were conducted during the pandemic and looked at measures of wellbeing and mental health. Lack of choice over whether to work from home was also considered in respect to wellbeing. Further measures linked to the home-work environment included feeling in control of time, lack of commuting to work, more time with the family, lower work/family conflict, and spaces shared with others. Openness to new ways of living was also included. Fifteen studies suggested overall that working at home may have more negative consequences during the COVID-19 pandemic for women and, in particular, mothers. There was very little evidence to tell us how a person’s age, ethnicity, education or income might affect their health when working from home. Conclusions Many factors determine whether someone works at home, and the effects on their health and wellbeing. These are related to what is happening in the world, the employer and type of job, and the circumstances of the employee. Scientific summary Introduction Understanding the impact of working from home on health and wellbeing is highly topical and of great interest to employers and employees alike, with a strong need for up-to-date guidance. There is therefore a need to formally and systematically synthesise evidence from both before and during the COVID-19 pandemic to understand the potential impact of current trends in home working and hybrid working and how negative impacts might be mitigated. Methods We undertook a systematic review synthesising qualitative, quantitative and observational data. The overall aim of this review was to identify, appraise and synthesise existing research evidence that explores the impact of home working on health and wellbeing outcomes for working people and health inequalities in the population. Database searching was accompanied by the following additional search methods: scrutiny of reference lists of included papers; searches for UK grey literature; citation searching of key included papers. We extracted and tabulated key data from the included papers. Data extraction was performed by one reviewer, and checked for accuracy and consistency by a second reviewer. Quality (risk of bias) assessment was undertaken using appropriate tools for the types of study designs included in the review. The extracted data have been synthesised narratively due to the diverse nature of the evidence.1 Factors associated with the relationship between home working and health outcomes reported in the literature were displayed by constructing mind maps2 of each individual association which had been identified. The findings from our review were combined with an a priori model3 to develop a final model which was validated in consultation with stakeholders. Inclusion criteria Population The population included anyone in the working population who spends all or some of their working time at home. Papers which look at students, and those studying, rather than undertaking paid employment at home, were excluded from this review. Studies which looked at the impact of temporary remote teaching on teachers (where that was not their normal mode of teaching) as a result of COVID-19 lockdown measures were also excluded from the main review (these studies are discussed separately; see Supplementary Material: Full paper excluded studies. Studies from Organisation for Economic Co-operation and Development4 countries only were included in the review. Exposure This included hybrid models of home working where some time is spent working at home and some in the office or other traditional place of work. Other aspects of flexible and remote working which do not relate directly to home working,, for example studies about flexible office hours or specifically about working in remote locations away from the home, along with the impact of work accessibility (e.g. the impact of remote access to emails on home life), were considered to be outside the scope of this review. Context The extent to which people have been asked to work at home has escalated dramatically in response to the COVID-19 pandemic and much of the recent evidence relates to the specific circumstances of home working during the pandemic. The review and model take steps to take account of this by considering evidence from both before and during the pandemic and also considering the implications for future research and policy directions. Outcomes Any factor that has been shown to be associated with the health of people working at home was included. An association is defined as the link between two variables (often an exposure and an outcome) which is not necessarily a causal relationship. This included all measures of physical health (including self-reported outcomes) and mental health (including clinical indicators such as diagnosis and treatment and/or referral for depression and anxiety alongside self-reported measures). All measures associated with wellbeing including but not limited to wellbeing, happiness, mood and stress-related outcomes were included. Work satisfaction, along with all other employment-related outcomes such as job performance and work-life balance, as outside the scope of this review. Studies We included quantitative, qualitative, mixed-method and observational studies. Studies with and without a comparator group were included. Books and dissertations were excluded (but references were checked for relevance in specific cases). Case studies were considered on an individual basis in terms of their study design and risk of bias. Results In total, 96 pieces of relevant evidence were identified and included. Of 96 studies which were found to meet the inclusion criteria for the review, 30 studies were published before the COVID-19 pandemic (or using data from before the COVID-19 pandemic, without making particular reference to it) and a further 66 were published during the pandemic (and made specific reference to COVID-19 and the pandemic influence on home working). This demonstrates the significant increase in the evidence base throughout 2020–2021 as a result of working from home in the pandemic. Overall, the quality of evidence was limited by the study designs employed by the authors, with the majority of studies being cross-sectional surveys (n = 59), mostly conducted online during the COVID-19 pandemic. For the most part, for studies which collected quantitative data, measures were self-reported. A small number of studies used validated scales to measure specific outcomes such as wellbeing, quality of life (QoL), general health, anxiety and depression. Pre-COVID studies Prior to the COVID-19 pandemic, the evidence base for the impact of working from home on overall health was limited. We identified only seven studies which considered these factors.5–11 A more substantial volume of evidence exists which consists of 24 studies considering the effects of working at home on a broad range of wellbeing and mental health-related measures prior to the COVID-19 pandemic.6,12–34 COVID-19 studies As a result of the COVID-19 pandemic and work-at-home orders given as part of lockdown restrictions in many countries the evidence base on the health impacts of working from home has developed rapidly in the last two years. However, the focus on wellbeing over physical health persists and most studies consisted of cross-sectional survey data with self-reported outcomes. Even as a result of increased working from home due to COVID-19 the volume of literature linking working at home with general health outcomes has not increased substantially. A further five studies linking the outcomes of QoL, higher demands and lifestyle factors (diet and alcohol intake) show an inconsistent picture in terms of their associations with working at home.35–39 The COVID-19 pandemic has also resulted in a slight increase in the number of studies reporting factors which influence the associations between working at home and physical health measures.40–46 Notably all the factors reported had a negative impact on the health outcomes (or no association was found). The largest volume of evidence identified consisted of studies conducted during the COVID-19 pandemic which looked at factors which influence the associations between working from home and measures relating to mental health and wellbeing.17,35,42,44,45,47–59 A broad range of measures relating to wellbeing were used by study authors including direct measures of wellbeing and measures of mental health (including negative affect, anxiety, depression, psychological distress) and stress (including perceived stress, perceived self-efficacy, ‘stress, worry and pressure’, burnout, ‘cognitive worsening’ and specific stress including parenting stress and occupational stress). Measures linked to wellbeing included sleep (sleep quality, time sleeping and fatigue), alcohol use and physical activity (PA)/inactivity (opportunity to exercise, sedentariness, standing and movement, lack of sports facilities open). Increased health concerns were also reported, as were factors linked with social interaction (social isolation, loneliness, minimal contact with others and social support). Satisfaction with working from home (including sense of worthwhile life) and QoL measures were also reported. Lack of choice over whether to work from home along with work autonomy and measures linked to videoconferencing (videoconference fatigue and technostress) were also considered in respect to wellbeing. Further measures linked to the home-work environment and wellbeing included feeling in control of time, lack of commute, more time with the family, lower work/family conflict, and spaces shared with others. Openness to new ways of living was also included. Inequalities and studies which consider sub-populations A total of 15 studies considered the potential for working at home to have different effects for different subgroups of the population.12,27–30,38,42,50,60–67 A combination of studies which recruited specific sections of the population and those which included subgroup analyses within their reported results suggested overall that working at home may have more negative consequences during the COVID-19 pandemic for women and, in particular, mothers. However, it was impossible to tell whether this was primarily as a result of lockdown-related childcare responsibilities and home schooling or related to other aspects of home working during the pandemic. There was very little evidence on age, ethnicity, education or income in terms of moderating home working effects, and very limited evidence from before the COVID-19 pandemic. The impact of COVID-19 on working from home A notable omission from the evidence is that the concept of enforced working from home and having ‘no choice’ was reported in only one paper prior to the pandemic and two papers reporting on working from home as a result of COVID-19 and the associated lockdown measures. However, the concept of lack of choice around working from home was implicit in much of the literature published during COVID-19 – even though it was not directly measured. Surprisingly, there were no clear patterns of wellbeing measures which changed from positive to negative association (or vice versa) during the pandemic. This is of course determined by what authors chose to measure and report, and the paucity of evidence on wellbeing measures prior to the pandemic, so should in no way be taken to suggest that pandemic home working did not have an effect on wellbeing overall. Numerous factors such as space available at home, the presence of children or housemates, and employee expectations around workload and working hours were relevant to health and wellbeing while working from home. Further it is impossible to separate out the effects of COVID-19 lockdown and uncertainties on wellbeing from the direct impacts of home working during this time on wellbeing, particularly for studies conducted during the early stages of the pandemic. In terms of physical and overall health measures, the significantly smaller number of studies measuring these types of association both before and during the COVID-19 pandemic made it even more challenging for any potential patterns to be identified. However, there is some indication that the association between working at home and PA measures became more negative during the COVID-19 pandemic, with five studies reporting reduced PA (compared with a more mixed picture before the pandemic of two studies reporting positive factors, one negative, and one reporting no effect). This is unsurprising given the lockdown measures in which home working was implemented, during which time sports facilities, leisure centres and gyms were closed. Conclusions The evidence base for the factors which influence the associations between home working and health-related outcomes has expanded significantly as a result of the need for those whose work could be done from home to work at home during the COVID-19 pandemic. However, it remains limited in terms of study quality and is focused on mental health and wellbeing-related measures at the expense of measures of physical and overall health. Due to the rapidly expanding nature of the evidence on this topic, it is possible that new studies were published after the final citation searches were conducted (November 2021) and before completion of this synthesis (mid-December 2021). The quality of the evidence base was very much limited by study designs, particularly for studies published during the COVID-19 pandemic, with the majority of studies consisting of data collected by cross-sectional surveys (often online). The current evidence base is not strong enough to determine whether certain individual factors are most important in the pathway between home working and health outcomes and there is a further lack of evidence to determine which groups within a population might be at greatest risk of negative outcomes. However, the findings of our systematic review and resulting model of factors which influence the associations between working at home and employee health suggest that there are factors relating to the external context, the role of employers and the circumstances of the employee which contribute to determining whether someone works at home and what the associated impacts on health and wellbeing may be. External drivers and current trends, as well as the COVID-19 pandemic, contribute to the contextual factors. The employer response is determined by their capacity and willingness to allow and/or mandate home working and hybrid options. If those choices are offered, then the individual factors relating to the employee, their job and their home environment (including their exposure to health inequalities) determine whether they are enabled to choose to work at home, and ultimately whether their experience is positive or negative in respect to the impact on their health and wellbeing. Learning from the COVID-19 lockdown experience will be important to inform future policy on home working. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (project reference 18/93 PHR Public Health Review Team) and will be published in full in Public Health Research; Vol. 11, No. 4. See the NIHR Journals Library website for further project information. Study registration This study is registered as PROSPERO 2021 CRD42021253474

Evaluating the impact of local alcohol licensing decisions on outcomes for the community: a systematic review

Background International evidence reviews suggest that reducing the availability of alcohol positively impacts both levels of alcohol consumption and associated harms. To understand the impact of recent changes to alcohol licensing and public health in the UK, this review aimed to identify and synthesise quantitative research evidence on the impact of local alcohol licensing decisions on the health and well-being of the community.Methods We searched peer-reviewed articles and grey literature for UK studies. We extracted and tabulated key data from the included papers and appraised study quality. We included topic expert and public consultation to confirm the scope of the evidence synthesis and suggest evidence for inclusion. We synthesised narratively and made recommendations based on our findings.Results We identified a small volume (seven papers) of evidence regarding the health (and related) impacts of local alcohol licensing decision undertaken in the UK local authorities. The evidence we identified did not demonstrate a consistent or sustained association between local interventions and health or crime outcomes downstream. This was despite relatively sophisticated study designs using a range of available data sources and some longer-term analysis.Conclusion Given that the impacts of local licensing decisions are currently limited, greater regulatory powers are needed if local licensing interventions are to be an effective public health interventions to reduce alcohol-related harms

3D Hydrogel System with Continuous Stiffness Gradient

Traditional 2D cell culture protocols poorly represent in vivo conditions. Methods to allow culturing of patient derived cells in scaffolds that closely mimic the 3D environment would be of great clinical value. Parameters to consider are tissue stiffness, chemical and stiffness gradients, and the ability to co-culture various cell types. This project aimed to create a 3D hydrogel system in a range of stiffness comparable to body tissues while allowing cell growth and differentiation in a 3D environment. The design utilized a fast gelling hydrogel and a cross-linker that allowed controlled stiffness. This was combined with a microfluidic gradient generator to produce a 3D hydrogel with a continuous stiffness gradient. This approach can be a valuable tool for tissue engineering research

External intelligence capability as a dynamic capability for achieving superior organizational performance

Hock Tee Koh, Graham L. Hubbard, Pi-Shen Seet, Joo Seng Tanhttp://www.anzam.org

The Impact of Tourism on the Venice Public Transportation System

The number of tourists visiting the city of Venice every year has rapidly been increasing, verging on unsustainability, especially during the summer months. The public transportation network has become more congested. This project investigated the impacts of tourism on the public transportation system by collecting ridership data from the popular boat stops and comparing the counts to the number of cruise ships present for each day. The project concluded that cruise ship passengers increased public boat use by a factor of 2 at the least, and a factor of 4 at the most. These data may prove essential to further understanding how tourism, as well as the extensive public boat system, might be modified to insure the continuing health and prosperity of Venice