Current Global Use Research Articles

The Real-World Global Use of Patient-Reported Outcomes for the Care of Patients With Inflammatory Bowel Disease.

Many patient-reported outcomes (PROs) have been developed for inflammatory bowel disease (IBD) without recommendations for clinical use. PROs differ from physician-reported disease activity indices; they assess patients' perceptions of their symptoms, functional status, mental health, and quality of life, among other areas. We sought to investigate the current global use and barriers to using PROs in clinical practice for IBD. A cross-sectional survey was performed. An electronic questionnaire was sent to an international group of providers who care for patients with IBD. There were 194 respondents, including adult/pediatric gastroenterologists, advanced practice providers, and colorectal surgeons from 5 continents. The majority (80%) use PROs in clinical practice, 65% frequently found value in routine use, and 50% frequently found PROs influenced management. Thirty-one different PROs for IBD were reportedly used. Barriers included not being familiar with PROs, not knowing how to incorporate PRO results into clinical practice, lack of electronic medical record integration, and time constraints. Most (91%) agreed it would be beneficial to have an accepted set of consistently used PROs. The majority (60%) thought that there should be some cultural differences in PROs used globally but that PROs for IBD should be consistent around the world. PROs are used frequently in clinical practice with wide variation in which are used and how they influence management. Education about PROs and how to use and interpret an accepted set of PROs would decrease barriers for use and allow for global harmonization.

A Layer Plus Approach to Implementation Research and Collaboration for Long-Acting Injectable Preexposure Prophylaxis for HIV Prevention.

In 2020, the HIV prevention clinical trials, HPTN (HIV Prevention Trials Network) 083 and 084, reported that long-acting injectable cabotegravir (CAB-LA) for HIV prevention was statistically superior to daily oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) for pre-exposure prophylaxis (PrEP) in cisgender men and transgender women who have sex with men, and cisgender women. However, clinical efficacy does not translate to real-world effectiveness and clinical practice as evidenced by current global use of oral PrEP. There are ~626,000 users of PrEP, which is significantly below the 3 million goal set by UNAIDS for 2020. Implementation will be key to ensuring that CAB-LA reaches those who desire to use it. We describe the Layer Plus Approach for CAB-LA for PrEP dissemination and implementation. The "Layer" is focused on integrating CAB-LA into existing PrEP models of care and understanding the best delivery channels that could be established in existing programs. Important implications of layering include preparing health professionals to provide CAB-LA, improving access for potential users, and addressing existing PrEP structural and facility barriers. "Plus," which accounts for the existing disparities in PrEP access and use, means expanding CAB-LA to reach individuals for whom HIV prevention options have not been accessible or who have lapsed on oral PrEP. Implications for Plus include the development of new structures, systems, policies, and processes. A key aspect to the Approach is building collaborations to aid successful implementation. The Layer Plus Approach is a simple but strategic framework or a tailored approach to guide dissemination research and implementation.

A Review of Recycling Status of Decommissioned Lithium Batteries

This review analyzes the current global use of lithium batteries and the recycling of decommissioned lithium batteries, focusing on the recycling process, and introduces the status of domestic and foreign recycling industry of decommissioned lithium batteries. It also points out the existing problems and the prospects for the future development of the decommissioned lithium batteries recycling in China.

English

A sulphate solution of cobalt (18.93 g/L Co2+) containing major impurities such as copper (1.35 g/L Cu2+), iron (0.28 g/L Fetot), zinc (0.70 g/L Zn2+) and manganese (4.83 g/L Mn2+) was purified through the solvent extraction method using two extractants; MEXTRAL and D2EHPA for the removal of copper and for the removal in two stages of a zinc-iron-manganese complex respectively. The effects of the solution’s pH, O/A ratio, extraction time and stirring intensity were investigated. The purification extent was enhanced by optimizing these four parameters through Taguchi’s L16 (4^4) experimental. The final solution obtained through sequential extractions showed a reduction in Cu, Fe, Zn and Mn content of 98.7, 97.5, 98.2, and 80.5% respectively. This study showcased the possibility of obtaining high purity cobalt as a precursor for Lithium ion battery applications, representing 49% of its current global use. The coextraction value of cobalt was estimated at 6.2%. Key words: Purification, MEXTRAL 984N, D2EHPA, cobalt, SX.

Utilization of the Public Health Ordinance to prevent nosocomial spread in a case of acute measles-associated psychosis

Measles is a highly contagious disease. A 24 years old patient, recently exposed to measles (unvaccinated), presented in the emergency department with severe agitation, compatible with an acute psychotic episode, during the measles epidemic which spread in Israel in 2018–2019. Upon hospital admission, strict isolation was instructed, yet, without compliance, probably due to the patient’s status. Measles diagnosis was promptly confirmed. As measles transmission was eminent, public health measures were employed through immediate implementation of the section 15 of the Public Health Ordinance, allowing for compulsory short-term isolation. The patient’s condition improved within a few days and the measures were no longer necessary. This measles case occurred in the pre-Coronavirus disease 2019 (COVID-19) epidemic when use of a Public Health Ordinance was considered an extreme measure. This is in contrast to the current global use of Public Health laws to enforce strict quarantine and isolation on persons infected or potentially exposed to COVID-19. Nevertheless, minimizing infectious diseases transmission is a core function of public health law. Utilizing legal enforcement in circumstances of immediate public health hazard, such as nosocomial measles transmission, necessitates careful consideration. The integrative clinical and public health approach and prompt measures employed in this exceptional case, led to prevention of further infection spread.

Current global status and future development of traditional Chinese medicine in the prevention and treatment of Coronavirus Disease 2019

Recognizing the potential of globalizing traditional Chinese medicine (TCM) for coronavirus disease 2019 (COVID-19), this review summarizes the current global use of TCM for COVID-19, status of the internationalization of TCM, and strategy on globalizing TCM for COVID-19. COVID-19 is a novel coronavirus disease that has sparked a pandemic in March 2020 affecting over 110 countries. Although researchers have been racing to develop targeted anti-COVID-19 treatment and vaccine, they are still currently unavailable. Thus, in treating patients infected with COVID-19, western medicine mainly recommended symptomatic treatment and monitoring. Existing drugs are used in the context of clinical trials, and the FDA still not yet approved these drugs for COVID-19. On the other hand, TCM proposed herbal treatment for suspected individuals to take within their observation period, as well as for confirmed COVID-19 patients to take during active phase of disease and during recovery. In China, Integrative Chinese-Western Medicine had been used in treating 91.5% of COVID-19 patients and showed its strength in reducing disease severity, shortening recovery time, and lowering the mortality rate. Despite obstacles in globalizing TCM for the treatment of COVID-19, promoting appropriate use of locally registered TCM products may prevent disease in susceptible individuals, improve the quality of life, and assist in the recovery of COVID-19 patients. With increasing global acceptance, TCM may play a more important role in the battle against infectious disease in the future.

Using listening journals to raise awareness of Global Englishes in ELT

With the increasing use of English as a Lingua Franca (ELF), it is no longer appropriate to associate English purely with �native-speaking� nations, but with a global community of users. This article reports on the use of listening journals in ELT to expose students to global Englishes (GE), a field that reflects the current global use of English. These journals served as a pedagogical task, and as a research instrument that involved the analysis of 108 journals consisting of 1,092 reflections on GE exposure. The results highlighted students� current use of English, the impetus behind the selection of material for the listening journal, and their reflections on this exposure. The study not only shows a benefit in using listening journals to raise awareness of GE but also highlights limitations, including the reinforcement of stereotypes and a tendency to reflect on attitudes towards different varieties of English rather than how successful ELF communication is achieved.

Reverse innovation in global health systems: towards global innovation flow

Reverse innovation in global health systems: towards global innovation flow

The WHO–ILAR COPCORD Bhigwan (India) model: foundation for a future COPCORD design and data repository

Launched by the International League of Associations for Rheumatology (ILAR) and the World Health Organization (WHO), the Community oriented program for control of rheumatic diseases (COPCORD) aims to fill the gaps in the knowledge on the global burden of rheumatic musculoskeletal disorders (RMS). During the population survey (Stage I), data on symptoms (pain and disability in focus), rather than diseases or syndromes, is collected. The survey may be followed by a planned stage to impart health education, identify risk factors, and devise preventive and control strategies. Several countries in the Asia Pacific and Pan-America have completed COPCORD survey. Africa has recently joined. Only COPCORD Bhigwan (India) has continued into the tenth year. COPCORD Bhigwan is a fast-track model that has provided significant data on rheumatic disorders. Using COPCORD Bhigwan model, the Bone and Joint Decade (BJD) India has launched several population surveys to measure the RMS burden. There is an urgent need for a COPCORD data repository. Several COPCORD have differed in their methods. Differences pertain to population sample size, techniques for data collection and recording, chronology of events and phases, and classification of symptoms/diseases/disorders. The COPCORD model in current global use needs to be revised. Based on the COPCORD Bhigwan model, a future design for COPCORD is proposed. COPCORD needs to have a uniform and standardized core program with a flexibility to cater to regional needs. It must imbibe some of the recent advances in rheumatology while retaining its socioeconomic appeal. It must have a planned follow-up/longitudinal observational phase. Above all, it must serve and benefit community. WHO-ILAR COPCORD and the global BJD initiative must join hands to serve a common cause of controlling rheumatic musculoskeletal disorders. COPCORD is also a reflection of the ILAR mission statement "think global, act local."

Toxicological Aspects of the South American Herbs Cat???s Claw (Uncaria tomentosa) and Maca (Lepidium meyenii)

Recent exceptional growth in human exposure to natural products known to originate from traditional medicine has lead to a resurgence of scientific interest in their biological effects. As a strategy for improvement of the assessment of their pharmacological and toxicological profile, scientific evidence-based approaches are being employed to appropriately evaluate composition, quality, potential medicinal activity and safety of these natural products. Using this approach, we comprehensively reviewed existing scientific evidence for known composition, medicinal uses (past and present), and documented biological effects with emphasis on clinical pharmacology and toxicology of two commonly used medicinal plants from South America with substantial human exposure from historical and current global use: Uncaria tomentosa (common name: cat's claw, and Spanish: uña de gato), and Lepidium meyenii (common name: maca). Despite the geographic sourcing from remote regions of the tropical Amazon and high altitude Andean mountains, cat's claw and maca are widely available commercially in industrialised countries. Analytical characterisations of their active constituents have identified a variety of classes of compounds of toxicological, pharmacological and even nutritional interest including oxindole and indole alkaloids, flavonoids, glucosinolates, sterols, polyunsaturated fatty acids, carbolines and other compounds. The oxindole alkaloids from the root bark of cat's claw are thought to invoke its most widely sought-after medicinal effects as a herbal remedy against inflammation. We find the scientific evidence supporting this claim is not conclusive and although there exists a base of information addressing this medicinal use, it is limited in scope with some evidence accumulated from in vitro studies towards understanding possible mechanisms of action by specific oxindole alkaloids through inhibition of nuclear factor (NF)-kappaB activation. Although controlled clinical studies have demonstrated reduction in pain associated with cat's claw intake in patients with various chronic inflammatory disorders, there is insufficient clinical data overall to draw a firm conclusion for its anti-inflammatory effects. An important observation was that experimental results were often dependent upon the nature of the preparation used. It appears that the presence of unknown substances has an important role in the overall effects of cat's claw extracts is an important factor for consideration. The available animal toxicological studies did not indicate severe toxicity from oral intake of cat's claw preparations but rather were suggestive of a low potential for acute and subacute oral toxicity, and a lack of evidence to demonstrate genotoxic potential and mutagenic activity. Maca is a clear example of a herb with substantial medicinal use in traditional herbal medicine by indigenous cultures in South America since the first recorded knowledge of it in the seventeenth century. The hypocotyls of maca are the edible part of the plant used for nutritional and proposed fertility-enhancing properties. Maca has been described to possess many other medicinal properties in traditional herbal medicine but only a few of them have been well studied scientifically. Published clinical studies of maca seem to be related to its property as a nutrient, for male fertility and for energy. There are inadequate data regarding the precise mechanism of action of maca. Some studies suggest that secondary metabolites found in maca extracts are important constituents responsible for its physiological effects. Maca has been reported in the scientific literature to have a low degree of acute oral toxicity in animals and low cellular toxicity in vitro. An important finding unveiled by this review is the importance of standardisation in quality and additional basic and clinical research to scientifically validate and understand composition, biological activity, safety and risk. Development of a comprehensive pharmacological and toxicological profile through critical evaluation of existing and future experimental data, especially carefully conducted clinical studies would facilitate the scientific evidence-based approach to understanding potential biological effects of these major traditionally based herbals in current global use.

Global use and trade of feedstuffs and consequences for the nitrogen cycle

This paper presents an estimate of the amount of nitrogen involved in the use and trade of feedstuffs for a number of world regions. Livestock production has shown a steady increase world-wide as a result of an annual increase of 1.4% in developing countries and 0.9% in developed countries during the period 1960–1990. Particularly in developing countries, the strong growth of animal production and a tendency towards decreasing reliance on grazing and increasing importance of fodder crops and feed concentrates, cause a major increase in the consumption of feedstuffs. Cereals form the major feedstuff world-wide. The current global use of cereals for feed is about 30% of the total use (57% in developed countries and 17% in developing countries). Net trade of cereals and other feedstuffs represents 4–8 Tg N per year, which is only 4–7% of the total N consumption by the world's animal population. A strong growth of the per capita food consumption, a relative increase of meat consumption, coupled with a strong population growth, may cause a strong increase of the net trade of cereals. In particular the countries of the Middle East, North Africa and China may become important importers of cereals. In future, the N transport between regions in the form of feedstuffs may become an important component in the global N cycle.