Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK.

BACKGROUND: A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. METHODS: This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. FINDINGS: Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0-75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4-97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8-80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3-4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. INTERPRETATION: ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials. FUNDING: UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, Bill & Melinda Gates Foundation, Lemann Foundation, Rede D'Or, Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK

Background A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. Methods This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. Findings Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0–75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4–97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8–80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3–4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. Interpretation ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials

Investimento direto externo e comércio exterior da China nos anos 1990 e 2000

Considering the up ahead tendency of trade and foreign direct investment (FDI) flows in Chinese economy, the present study investigated the relationship between FDI and the changes verified in China s export structure towards high-tech sectors. First, it was examined China s trade pattern of specialization, trough the use of international trade indicators as market-share, revealed comparative advantage (VCR) and contribution to trade balance (CTB) and the geographic pattern of China s foreign trade, considering its main trade partners. Second, it was estimated a model of the determinants of Chinese exports performance, contributing to earlier studies, when considering the different impacts of FDI on export structure classified according to its technological intensity, through time series analyses and VAR model estimation with variance decomposition analysis. The main results confirm the hypothesis that changes in China s trade pattern of specialization converged to international trade evolution, which means that China rose its share in dynamic sectors, that is, sectors that presents an growing foreign demand. This stimulated China s integration with the global trading system and increased the importance of intra-industry trade flows. The econometric estimation suggested that FDI had different impacts among export sectors, which means that, FDI is more efficient in promoting exports from those sectors more technologicalintensive. Besides that, other independent variables utilized in estimation seems to have a better importance than FDI, mainly investment rate, which is consonant with China s economic performance that presents an average growth rate of 10% per year for at least two decades.Fundação de Amparo a Pesquisa do Estado de Minas GeraisMestre em EconomiaAo constatar a tendência crescente dos fluxos de Investimento Direto Estrangeiro (IDE) e dos fluxos de comércio na economia chinesa, o presente estudo buscou investigar a relação entre o IDE e as mudanças verificadas na pauta de exportações da China em direção aos setores de alta intensidade tecnológica. Para isso, em primeiro lugar, verificou-se a evolução do padrão de especialização comercial da China, a partir dos indicadores de comércio market-share, vantagem comparativa revelada (VCR) e contribuição ao saldo (CS), e o padrão geográfico do comércio exterior da China, considerando seus principais parceiros comerciais. Em segundo lugar, foi estimado um modelo dos determinantes das exportações da China, avançando sobre estudos empíricos anteriores, ao considerar os efeitos diferenciados entre o IDE e os setores de exportação classificados segundo a intensidade tecnológica, através da análise de regressão de séries temporais e da estimação do modelo VAR com a análise de decomposição de variância. Os principais resultados corroboram a hipótese de que as mudanças no padrão de especialização comercial da China convergiram à evolução do comércio internacional, vale dizer, a China ampliou sua participação em setores dinâmicos, isto é, que apresentaram uma demanda externa crescente, o que impulsionou sua integração ao mercado mundial e a importância dos fluxos de comércio do tipo intra-industrial. Na análise econométrica, as estimações corroboram a hipótese de que o IDE teve efeitos diferenciados entre os setores de exportação, sendo que sua importância é maior nos setores de exportação com maior conteúdo tecnológico. Além disso, outras variáveis explicativas utilizadas na estimação parecem possuir uma importância maior que o IDE , com destaque para a taxa de investimento da economia, o que é consoante com a performance econômica da China que apresenta uma taxa de crescimento média de 10% ao ano a mais de duas décadas

Within-product specialization : export performance of Brazil and China in vertically differentiated varieties

Orientador: Célio HiratukaTese (doutorado) - Universidade Estadual de Campinas, Instituto de EconomiaResumo: Estudos recentes, utilizando classificações de mercadorias com um alto grau de detalhamento, constataram em um mesmo produto e mercado de destino, grandes diferenças de preços entre os países exportadores. Estabeleceu-se a visão de que a especialização comercial ocorre no interior da categoria de produto, ao longo de variedades. A princípio, variedades são mercadorias sob um mesmo código, mas vendidas a valores unitários distintos (diferenciação vertical de produto). A literatura emergiu nos países desenvolvidos, preocupada com os efeitos da concorrência com as variedades dos países de baixos salários. Essa nova visão da especialização comercial é o ponto de partida para tratar de um tema de grande apelo no contexto atual, o da concorrência com os produtos chineses em terceiros mercados. O trabalho procura contribuir com o tema, investigando a importância do comércio em produtos verticalmente diferenciados na caracterização do padrão de especialização comercial do Brasil comparativamente à China, considerando os principais mercados consumidores de manufaturados brasileiros (ALADI, MERCOSUL e NAFTA). A análise observa diretamente os valores unitários dos fluxos de comércio para inferir sobre a qualidade relativa dos produtos exportados entre o Brasil e a China. Alternativamente, por meio de uma equação de regressão com dados em painel, utiliza dados de preço e quantidade exportados para estimar a influência da `margem qualidade¿ no crescimento das exportações para cada mercado de destino selecionado. O período de análise são os anos 2001 a 2010; os dados são oferecidos por uma nova base de dados de comércio internacional, a BACI. Em geral, as evidências encontradas mostram que o Brasil resistiu melhor a concorrência com os produtos chineses nos segmentos de preço médio e superior, pois foram os segmentos em que ampliou a sua participação (até 10,0 pontos percentuais); esse resultado é observado nas diferentes indústrias e mercados de destino selecionados. Em relação à importância da `margem qualidade¿ no crescimento das exportações, os resultados das estimações mostraram que há diferenças entre os países exportadores quanto à qualidade das exportações nos diferentes mercados de destino; os países de renda per capita mais alta tendem a exportar maiores quantidades, a preços até 12,0% mais altos. Isso significa que há espaço para os países em desenvolvimento aumentarem a qualidade de suas exportações, o que deve ser complementar ao esforço de diversificação da pauta de exportaçõesAbstract: Recent studies, using highly detailed commodity classifications, have found large price differences among exporting countries, considering the same product and destination market. The idea that trade specialization occurs within product, along varieties, was established. Originally, varieties are goods under the same code but sold with different unit values (vertical product differentiation). The literature has emerged in developed countries, worried about the effects of competition with the varieties of low-wage countries. This new approach to trade specialization is the starting point for discussing a topic of great appeal in the current scenario of competition with Chinese products in third markets. This study aims to contribute to the discussions on that topic, investigating the importance of trade in vertically differentiated products in characterizing the patterns of trade specialization of Brazil in comparison with China, considering the main destination markets of Brazilian manufactures (LAIA, MERCOSUR and NAFTA). The analysis uses directly the unit values of trade flows to infer the relative quality of exported products between Brazil and China. Alternatively, by means of a regression equation with panel data, it uses price and quantity data to estimate the influence of the quality margin in the growth of exports for each selected destination market. The period of analysis comprises the years 2001 to 2010; the data are made available by a new international trade database, BACI. In general, the results show that Brazil has better resisted to the competition with Chinese products in the medium and upper segments of the market, because those were the segments in which Brazil has expanded its share (up to 10.0 percentage points); the observed results hold among different industries and selected destination markets. Considering the importance of the quality margin in the growth of exports, the results showed that there are differences between exporting countries regarding the quality of exports in the different destination markets; countries with higher per capita income export larger quantities, with prices up to 12% higher. This means that there is room for developing countries to raise the quality of their exports, and this should complement the efforts of export diversificationDoutoradoTeoria EconomicaDoutora em Ciências Econômica

Fluxos de investimento direto externo, competitividade e conteúdo tecnológico do comércio exterior da China no início do século XXI

Foreign direct investment flow, competitiveness and technological structure of foreign trade in China in the beginning of the 21st century. China's government introduced open market reforms in 1979, mediated by industrial policies improving the ability of attracting higher quality FDI (Foreign Direct Investment), which helped China's economy developing its technological capabilities. As a result, China's share in international trade rose impressively becoming third-largest trading nation in the world, by 2004, also its export structure is significantly more sophisticated. Facing the importance of understanding the determinants of developing word specialization patterns, this paper focuses on the competitiveness and technological structure of exports and imports by China for 1994-1998 and 2001-2005

China: padrão de especialização comercial, tecnologia e comércio intraindustrial

China´s economy has expanded its share of international trade since market-oriented reforms were implemented in 1979. At the same time, China has raised the technological content of its exports. This paper focuses on China´s trade pattern evolution in recent years, considering the composition of trade by technological intensity and analyses the bilateral trade flows between China and its main partners, verifying the importance of its integration in international production networks.<br>A China ampliou sua participação nos fluxos de comércio mundial, desde as reformas de abertura econômica em 1979. Ao mesmo tempo, verificou-se uma mudança na estrutura setorial de suas exportações em direção aos setores mais intensivos em capital e tecnologia, em detrimento daqueles primários e intensivos em trabalho. O objetivo do artigo é analisar a evolução do padrão de especialização comercial da China no período recente, a partir da classificação dos setores de exportação e importação segundo a intensidade tecnológica e abordar os fluxos bilaterais de comércio da China com seus principais parceiros comerciais, captando a importância da integração chinesa às redes de produção globais