National Efforts Research Articles

Environmental Sustainability in Dermatological Surgery. Part 2: Reducing Activity and Future Ecological Strategies.

This two-part review addresses the pressing need for environmental sustainability in dermatological surgery, driven by the NHS's commitment to net-zero emissions. Part 2 of this review extends the discussion of sustainability in dermatological surgery by focusing on system-wide changes in service delivery and identifying future opportunities for reducing environmental impact. Building on the strategies outlined in Part 1, which explored low-carbon alternatives and operational resource optimisation, Part 2 advocates for a comprehensive shift in the skin surgery service. Key strategies include reducing overall surgical activity, advancing research and innovation, and enhancing management practices to align with sustainability goals. Reducing surgical activity mainly involves the prevention of skin cancers, in addition to optimising current patient pathways and empowering patients to take ownership of their follow-up. Outside of immediate clinical decision-making at the individual level, the review highlights the importance of managerial policy, procurement practices and supply chain factors in driving broader national and international sustainability efforts. Advancing the sustainability agenda will also require targeted research and innovation, particularly in digital health solutions using evidence-based practices. By integrating these strategies, this review aims to provide a framework for reducing the environmental footprint of dermatological surgery and advancing towards a more sustainable healthcare system.

Sustainable education for underserved U.S. communities: Empowering students through environmental literacy and green job pathways

This research paper explores the integration of environmental literacy and sustainability-focused education within underserved U.S. communities, aiming to empower students and promote pathways to green jobs. As these communities often face significant educational disparities and limited economic opportunities, the study highlights the importance of environmental literacy as a critical component of education that fosters essential skills such as critical thinking, problem-solving, and civic engagement. The paper discusses best practices for developing and implementing sustainability-focused curricula, effective teaching strategies, and the significance of local partnerships between educational institutions and industry stakeholders. Furthermore, it emphasizes the potential for green jobs to drive economic growth while aligning with national efforts toward environmental justice and sustainable development. The findings underscore the necessity of a multifaceted approach involving policymakers, educators, and community leaders to create equitable opportunities and foster a sustainable future for underserved communities.

Effects of Injury Registry Data on Policy Making, Hospitalizations, and Mortality: Protocol for a Systematic Review and Meta-Analysis.

Initiated in 2021, a Brazilian project aims to establish a national injury registry, compiling comprehensive data on events and individuals across the country, irrespective of injury severity. The registry integrates information from prehospital and hospital care, diverse health systems lacking interoperability, and sectors such as firefighters and the police. Its primary goal is to enhance health surveillance by providing timely, high-quality information, guiding prevention strategies, and informing policy making. The project still aims to reduce long-term morbidity and mortality associated with injuries. A knowledge gap remains regarding the effects of injury registries in relation to policies and injury outcomes. This protocol outlines a systematic review and meta-analysis to answer "What is the effect of implementation and use of injury registry data on policy making, hospitalization, and mortality?" The systematic review follows PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, focusing on studies reporting results related to the implementation and use of injury registries, including trauma registries. Outcomes of interest include policy making, hospitalization rates or duration, and mortality. Registries within well-defined administrative boundaries will be included. Data will be collected from PubMed, Embase, Scopus, Web of Science, Lilacs, and references. Records will be independently screened by 2 reviewers, with any disagreements resolved through arbitration by a third reviewer. Homogeneous studies, with 3 or more evaluating the same outcome, may undergo meta-analysis. Subgroup analyses by registry type, injury groups, and other selected variables of interest will be conducted. Sensitivity analysis, risk of bias assessment, publication bias evaluation, and quality appraisal will also be performed. This systematic review will run from November 2023 to June 2024. No identical review was found. Search strategies were finalized, the bibliographic search started, duplicates were eliminated, and title and abstract screening began. Of 35 studies retrieved, 85 were excluded due to duplication, leaving 50 for selection. This study is timely, aligning with ongoing national efforts to implement an injury registry. By synthesizing available evidence, we will identify the potential of injury registries to guide the decisions of Brazilian policy makers. PROSPERO CRD42023481528; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=481528. PRR1-10.2196/55029.

National biodiversity data infrastructures: ten essential functions for science, policy, and practice

Abstract Today, at the international level, powerful data portals are available to biodiversity researchers and policymakers, offering increasingly robust computing and network capacities and capable data services for internationally agreed-on standards. These accelerate individual and complex workflows to map data-driven research processes or even to make them possible for the first time. At the national level, however, and alongside these international developments, national infrastructures are needed to take on tasks that cannot be easily funded or addressed internationally. To avoid gaps, as well as redundancies in the research landscape, national tasks and responsibilities must be clearly defined to align efforts with core priorities. In the present article, we outline 10 essential functions of national biodiversity data infrastructures. They serve as key providers, facilitators, mediators, and platforms for effective biodiversity data management, integration, and analysis that require national efforts to foster biodiversity science, policy, and practice.

When religious beliefs become an ideology to motivate a war

ABSTRACT Historical records confirm the peaceful coexistence of individuals from diverse religious and cultural backgrounds. This paper seeks to analyse the enduring conflict between Israel and Palestine as a case in point to illustrate how prolonged conflicts can transform religions into ideologies fuelling the quest for survival and justice, rendering political resolutions futile. Through a narrative review, it contends that decades of occupation, forced displacements, and expulsions from the sacred territories of various faiths have led to significant loss of life, economic stagnation, and global health crises, despite numerous United Nations efforts to broker peace. Emphasising the centrality of religion in this conflict, this narrative suggests avenues for future research and political deliberation.

Mapping of FinTech Ecosystem to Sustainable Development Goals (SDGs): Saudi Arabia’s Landscape

Financial technology (FinTech) has become an indispensable part of most of the business infrastructure around the world. The FinTech ecosystem provides this solution by providing a suitable environment for all financial techno services to synergize. This paper explores the relationship between FinTech programs in Saudi Arabia and the Sustainable Development Goals (SDGs). It highlights how these financial technology initiatives contribute to various SDGs by providing innovative solutions that enhance financial inclusion, improve access to essential services, and foster economic growth. Specifically, the study identifies connections between FinTech programs and SDG goals 1 (No Poverty), 2 (Zero Hunger), 5 (Gender Equality), 8 (Decent Work and Economic Growth), and 17 (Partnerships for the Goals). Through these linkages, this paper demonstrates the role of FinTech in promoting sustainable development and supporting national and global efforts to achieve these crucial objectives. Secondary data were collected from published reports, institutional and governmental websites, official portals, and research papers focusing on the companies operating in Saudi Arabia. It was found that FinTech in Saudi Arabia is addressing SDGs goals 1, 2, 5, 8 and 17. This paper further endeavors to map specific SDG indicators to the products and services provided by FinTech companies in Saudi Arabia. By doing so, it seeks to identify the areas where these technological solutions directly support the achievement of sustainable development targets. This comprehensive analysis is intended to be a valuable resource for institutions and policymakers in the FinTech industry. It provides insights into how these companies can align their offerings more closely with the SDG framework, thereby addressing any existing gaps. The findings aim to aid in the global agenda of eradicating poverty and promoting sustainable development opportunities by leveraging FinTech innovations.

Assessing progress towards viral hepatitis B and C elimination in prisons in the European region

Abstract Background In 2016 the WHO launched the global health sector strategy for the elimination of viral hepatitis, alongside a dedicated monitoring&evaluation (M&E) framework to assess progress at national, regional and global levels. Despite being a priority setting for viral hepatitis elimination in Europe, prisons are rarely integrated into national monitoring efforts. Besides, prisons are particular contexts with a high viral hepatitis prevalence, where it is possible to utilize adequate micro-elimination strategies. Objectives We aimed to assess available metrics of viral hepatitis burden and coverage of prevention and control interventions in prison settings in Europe using routine sources of data. Methods We adapted the WHO M&E framework for viral hepatitis elimination to the prison context. The resulting M&E framework has 49 indicators of which 10 are defined as core. Data were sourced from available European prison surveillance systems at European level, namely: European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and WHO Health in Prisons European Database (HIPED). Results In total 38 countries in the European region provided data to either data sources for 2020. For WHO-HIPED, among core indicators, 3 out of 10 could be calculated for HCV, and covered prevalence, HCV treatment availability and treatment outcome. Concerning HBV, 3 core indicators out of 10 could be calculated and covered prevalence, screening availability and treatment coverage in prison. With EMCDDA surveillance system we could calculate 4 HCV core indicators and 6 HBV core indicators. Lessons Availability of health data from prison settings is scarce, hampering the current capacity to monitor the progress in the viral hepatitis elimination within prisons contexts strategies and its relative contribution to global health goals achievement. A coordinated and standardised M&E framework tailored to this specific setting is needed to foster data collection and systematic monitoring. Key messages • Micro-elimination strategies in prison context contribute to the global health goals achievement. • A coordinated and standardized M&V framework, adapted to the prison context, is needed to foster data collection and monitoring of the viral hepatitis elimination strategy.

The role and needs of teachers/schools in infection, prevention and control post covid-19

Abstract Introduction COVID-19 highlighted the importance of infection prevention and control (IPC) across all settings. As children are important transmitters of infection, teachers and schools play an important role in infection prevention. The aim of this study is to understand attitudes towards, and knowledge of IPC in schools post-Covid, and highlight any gaps in the training and resources needed. Methods An online survey of 1000 primary and secondary school teachers was carried out across England. Pearson’s chi-squared test, corrected for survey design, was used to test for differences in proportions across levels of categorical variables. Two qualitative workshops with eight head teachers were carried out to gather more in-depth information. Results 1000 teachers completed the survey across a range of teaching roles. Respondents reported that IPC measures are now less frequently implemented than during the pandemic. 71% of respondents say their role has changed since the pandemic, now having more responsibility for pupil health and hygiene; higher in primary versus secondary school teachers (31% v 25%; p < 0.05). 1/3 felt this change was permanent; 84% had no IPC training. Knowledge gaps were identified in the areas of IPC roles within schools, and IPC measures. 72% teachers claim they feel better prepared to deal with a public health outbreak compared to pre-pandemic, although 22% do not have an updated IPC policy; 35% had unmet needs. Conclusions Schools and teachers play a pivotal role in preventing the spread of communicable disease, highlighted during the COVID-19 pandemic. Teachers need, and more importantly want, more IPC training. Training and updated policies would support the educational workforce who feel their needs are not being met. Providing more streamlined, consistent, clear and concise information from trusted sources is required. Key messages • It is imperative to understand educators’ role in IPC in schools as they are key players in supporting local and national efforts to reduce the spread of infections. • Teachers desire further training with comprehensive information, and up-to-date policies to support their infection prevention and control efforts in educational settings.

5.I. Scientific session: Epidemiological insights into vaccine hesitancy in Europe: building bridges and overcoming barriers

Abstract Vaccine hesitancy remains a pivotal challenge in public health, undermining immunization efforts and the containment of infectious diseases across Europe. This scientific session aims to dissect the complex nature of vaccine hesitancy, uncovering epidemiological trends and barriers to vaccine acceptance, particularly in diverse demographic contexts. The objective is to facilitate a comprehensive understanding among public health stakeholders and to foster actionable strategies through enriched dialogue and interaction. This session will delve into recent studies and projects that highlight the variability of vaccine hesitancy within Europe. First, an exploration of COVID-19 vaccine acceptance will reveal how sociodemographic factors influence vaccine-related behaviors across 20 European nations. This will be complemented by an analysis of targeted interventions designed to enhance vaccine uptake among migrant populations, drawing lessons from the RIVER-EU project. Additionally, a focus on national efforts to combat measles vaccine hesitancy will provide a case study on the challenges and successes in altering public health narratives. Based on the feedback received on last year’s session, the format is intended not only to provide a platform to present empirical evidence and insights but also to encourage a participatory environment where attendees can exchange ideas and propose innovative solutions. For this reason, the session will engage the audience through an interactive discussion period at the end of each of the three presentations, stimulating thought-provoking dialogues that could lead to effective and innovative public health practices. Fostering international and interdisciplinary collaboration in the field of vaccine hesitancy is key for continued monitoring and reporting on the vaccine hesitancy phenomenon and inspiring actionable solutions. Key messages • Sociodemographic factors are associated with vaccine hesitancy across Europe indicating the potential for targeted strategies. • A platform to share insights and inspire actionable public health solutions to combat vaccine hesitancy amomg European public health professionals is needed.

Introducing innovative policy instrument to reduce antibiotics use. Relevant evidence from Bulgaria

Abstract Background of the public health challenge Excessive individual consumption of antibiotics (ABs) increases global antimicrobial resistance (AMR). Therefore, shaping consumers’ behaviors towards responsible ABs use is an essential strategy in the battle with the silent pandemic of AMR. The EU One Health (OH) Action Plan against AMR targets making Europe a best-practice region. Overall consumption of ABs in the EU decreased significantly, especially during the COVID-19 pandemic. Bulgaria is the only EU country that has reported an annual increase in ABs use during this period (ECDC data). A growing part of Bulgarians, believe that ‘ABs kill viruses’ and is unaware that ‘unnecessary use of ABs makes them ineffective’ (Eurobarometer 2022). This limited understanding of adequate ABs use resulted in counterproductive behaviors that demand change. Introducing innovative policy instrument as a tool for behavioral change: Undeniably, drug prescription monitoring has the potential to change consumers’ behaviors. In October 2023 mandatory electronic prescribing (e-Rx) for ABs was introduced in Bulgaria at a primary healthcare level. Consequently, there was an observed decline exceeding 30% in ABs sales (IQVIA Bulgaria data), evidencing a reduction in ABs consumption. However, there were negative reactions by the stakeholders, due to time-consuming procedures, nonoptimal IT infrastructure, etc., and that led to e-Rx-moratorium. Finally, in April 2024, the e-Rx is sustainably introduced. Conclusions Legislative measures, like e-Rx, can hinder the chaotic use of ABs. Moreover, Bulgarians need to reflect on their behaviors and values of solidarity which OH offers. Herewith, a multidisciplinary team of academic educators unite their OH efforts in raising awareness related to AMR and the rational use of ABs. Years of national endeavors toward healthcare digitalisation led to the introduction of e-Rx for ABs in Bulgaria. Research will prove its relevance for the rest of Europe. Key messages • To the European community: The introduction of the innovative policy tool (e-Rx for antibiotics) in Bulgaria is a significant national effort in making Europe a best-practice region regarding AMR. • To the Bulgarian society: Antibiotics are not bonbons! Responsible ABs use of every one of us can contribute to the EU efforts to manage AMR. In the context of AMR, every person is a stakeholder.

The effects of RT-qPCR standards on reproducibility and comparability in monitoring SARS-CoV-2 levels in wastewater

Reverse transcription-quantitative PCR (RT-qPCR) is widely used for monitoring viruses, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in wastewater. Various materials, including plasmid DNA, synthetic nucleic acids, PCR amplicons, genomic DNA, and cDNA, are currently used for SARS-CoV-2 quantification by generating standard curves. We assessed three common standards on quantifying SARS-CoV-2 RNA across nine wastewater treatment plants in Finland, as part of the national wastewater surveillance effort. We pairwise compared RT-qPCR results from 148 wastewater samples, using both IDT (#10006625, IDT, USA) and CODEX standards (#SC2-RNAC-1100, CODEX DNA), and 179 samples using both IDT and EURM019 standards (#EURM-019, European Commission, Joint Research Centre) in our assessment. Amongst the tested standards, the CODEX standard consistently yielded more stable results than either the IDT or EURM019 standards. We found that SARS-CoV-2 levels were higher with the IDT standard (4.36 Log10 GC/100 mL) compared to the CODEX standard (4.05 Log10 GC/100 mL). Similarly, quantification using the IDT standard was higher (5.27 Log10 GC/100 mL) than values obtained with the EURM019 (4.81 Log10 GC/100 mL). SARS-CoV-2 RNA quantified with IDT and CODEX standards exhibited stronger concordance (Spearman’s correlation rho median of 0.79) compared to those quantified with IDT and EURM019 standards (rho median of 0.59). This study highlights the significant impact of standard material selection on SARS-CoV-2 RNA quantification, emphasizing the need for harmonization in standard material.

Future Scenarios of Forest Carbon Sink in a Typical Subtropical County

In the context of achieving global carbon neutrality, forests play a pivotal role in sequestering atmospheric CO2, particularly in China, where forest management is central to national climate strategies. This study evaluates the forest carbon sink capacity in Zixi County, a subtropical region, under varying climate scenarios (SSP2-4.5 and SSP5-8.5). Using the Forest-DNDC (Denitrification–Decomposition) model, combined with high-precision climate data and a random forest model, we simulate forest carbon density and forest carbon sink under different management strategies. The results indicate that under the baseline scenario, forest carbon density in Zixi County increases by 31% over 42 years under the SSP2-4.5 climate scenario and by 28.6% under SSP5-8.5. In the enhancing economic scenario, carbon density increases by 8.5% under SSP2-4.5 and by 7.2% under SSP5-8.5. For the natural development scenario, a significant increase of 130% is observed under SSP2-4.5, while SSP5-8.5 shows an increase of 120%. Spatially, forest carbon sinks in Zixi County total 843,152 T C in 2020, 542,852 T C in 2030, and 877,802 T C in 2060 under the baseline SSP2-4.5 scenario; under SSP5-8.5, these values are 841,321 T C in 2020, 531,301 T C in 2030, and 1,016,402 T C in 2060. In the enhancing economic scenario, the total carbon sink is 34,650 T C in both 2020 and 2030, increasing to 427,351 T C in 2060 under SSP2-4.5, while under SSP5-8.5, it is 46,200 T C in 2020, 34,650 T C in 2030, and 415,801 T C in 2060. The natural development scenario shows the total carbon sink under SSP2-4.5 as 11,157,332 T C in 2020, 3,441,910 T C in 2030, and 1,409,104 T C in 2060, and under SSP5-8.5, it is 10,903,231 T C in 2020, 3,337,960 T C in 2030, and 1,131,903 T C in 2060. Spatial analysis reveals that elevation and forest type significantly affect carbon density, with high-altitude areas and forests dominated by Chinese fir and broadleaf species showing higher carbon accumulation. The findings highlight the importance of targeted forest management, prioritizing species with higher carbon sequestration potential and considering spatial heterogeneity. These strategies, applied locally, can contribute to broader national and global carbon neutrality efforts.

A Case for a Maternal Culturally Tailored Smoking Cessation Research Agenda

Background/Objectives: Despite national efforts, smoking rates during pregnancy remain high among certain demographics, particularly American Indian/Alaska Native and younger women. This study examines the causal link between maternal smoking, maternal and fetal mortality, and social determinants of health, highlighting disparities faced by Black, Indigenous, and People of Color (BIPOC) and American Indian/Alaskan Native (AIAN) pregnant persons. Methods: Data from various sources, including national reports and committee findings, were analyzed to assess trends in maternal smoking, mortality rates, and associated factors. While smoking rates among all groups have declined, disparities persist. Young women, BIPOC, and American Indian/Alaska Native women, and those with lower educational attainment, have higher smoking rates. Black women exhibit significantly higher maternal mortality rates, often linked to cardiac/coronary conditions. Stress, exacerbated by social determinants of health like poverty and housing insecurity, emerges as a key factor driving smoking behavior, particularly among African Americans. The leading causes of pregnancy-related deaths vary by race and ethnicity, with preventability noted in 80% of cases. Perinatal exposure to cigarette smoking is also identified as a leading cause of poor infant health outcomes, emphasizing the importance of addressing smoking behavior during and after pregnancy. Results: This report advocates for a comprehensive approach to reducing maternal and fetal mortality rates, with a focus on adapting existing smoking cessation programs to adopt culturally tailored agendas in order to address social and political determinants of health as well as behavioral drivers of tobacco use among pregnant persons.

Utilization and determinants of maternity waiting homes among pastoralist mothers in Dire district, southern Ethiopia: a mixed-methods study

BackgroundMaternity waiting homes are cost-effective, World Health Organization-approved components of comprehensive prenatal, delivery, and postpartum care strategies. However, few community-based studies within Ethiopia's pastoralist communities, and none in the study area, have been conducted to determine actual usage or to gain a thorough understanding of the factors influencing utilization.MethodsA cross-sectional study, supplemented by qualitative methods, was conducted from June 25 to July 25, 2023. A simple random sampling technique was used to select 305 study participants. Data were gathered through an interviewer-administered questionnaire, entered into Epi-data version 3.1, and analyzed using SPSS version 25. Descriptive data were presented in tables, graphs, text, and percentages. Bivariate logistic regression identified candidate predictors at a P-value of <0.25, and predictors of maternity waiting home utilization were identified through multivariate logistic regression at a 95% confidence interval and P-value of <0.05. Qualitative interviews were transcribed, translated, and thematically analyzed.ResultsThe prevalence of maternity waiting home use in the study area was 35.2% (95% CI: 30.9%, 39.5%). Factors associated with maternity waiting home utilization included travel time greater than 60 min to nearby health facilities (AOR: 5.47 CI: 1.77, 16.91), good knowledge of danger signs of pregnancy (AOR: 5.41, CI: 1.86, 15.79), lack of a caretaker to household tasks (AOR: 0.1, CI: 0.03, 0.31), and a refusal to accept a waiting time of 2–4 weeks (AOR: 0.24 CI: 0.08, 0.74). The qualitative findings underscored hurdles such as resource constraints, challenges in providing maternity services, and the importance of community awareness and access to network connectivity in ensuring safe childbirth.ConclusionThis study aims to determine the utilization of maternity waiting homes and the factors associated with their use among women who gave birth within the last year in the Dire district, Borana zone, southern Ethiopia. The prevalence of maternity waiting home use was low compared to national efforts to promote this service. Longer travel time, lack of a caretaker, good knowledge of danger signs of pregnancy, and a refusal to accept a waiting time of 2–4 weeks were associated with maternity waiting home use in this study.

Perspectives on Medical School Admission for Black Students Among Premedical Advisers at Historically Black Colleges and Universities

There remains a lack of representation of Black physicians in the physician workforce despite decades of national efforts to increase diversity. Historically Black Colleges and Universities (HBCUs) contribute to increasing representation in the workforce in the US. There is limited literature exploring the experiences of HBCU premedical students navigating the journey to medical school. To examine barriers to and facilitators of medical school matriculation among Black students by exploring the perspectives of premedical student advisers at HBCUs. In this qualitative study, HBCU advisers participated in a focus group in October 2019 or in semistructured interviews from January 2020 to March 2021. Using purposive sampling, premedical student advisers were recruited from different educational backgrounds and geographic locations and conducted 1-on-1 interviews. Data analysis was performed from March 2021 to March 2022. The main outcome was the experiences of HBCU premedical students navigating to medical school from the perspective of premedical advisers. An inductive approach to generate codes from the interviews and the focus groups was applied by reviewing transcripts and noting concepts and themes associated with advising strategies and student experiences. Among the 26 participants, 18 (69.2%) were female, 13 (50.0%) had a doctorate degree, and 8 (30.8%) had more than 10 years of experience as advisers. Participants described 3 major themes: (1) the complex institutional relationship dynamics between undergraduate HBCUs and medical schools, (2) concerns about preferential treatment for students from predominantly white undergraduate schools when accessing clinical shadowing opportunities, and (3) the "it takes a village mindset" emphasizing family and peer involvement. In this qualitative study, barriers to medical school matriculation included concerns for the preferential treatment of students from predominantly white institutions when engaging with medical schools and a lack of access to clinical opportunities for HBCU students. The findings suggest that medical schools should continue to build collaborative partnerships with HBCUs to ensure equitable access to opportunities that prepare students for medical school.

The Unique Perspective of an Expert Humanitarian Nurse: A Case Study.

Nurses perform a key role in national and international humanitarian efforts. This case study of a highly experienced Registered Nurse who has engaged in international humanitarian projects for more than 30 years provides unique insight into the way nurses care for underserved populations. This nurse constructed knowledge and derived meaning from her practice by utilizing Carper's Patterns of Knowing. Many previous studies have proposed that Aesthetic Knowing is the dominant form of knowledge most nurses use to synthesize their understanding. However, in her personal account, this nurse identified Ethical Knowing as the overarching framework she used to construct all her other forms of knowledge and to derive meaning from her experiences. Findings from this case study identify significant themes related to the role of nurses in humanitarian work, and provide new insight into prevailing Western theoretical frameworks and how nurses can address health disparities among marginalized populations.

Proposed Quality Metrics for Congenital Cardiac Anesthesia: A Scoping Review.

Congenital cardiac anesthesiologists practice in a unique environment with high risk for morbidity and mortality. Quality metrics can be used to focus clinical initiatives on evidence-based care and provide a target for local quality improvement measures. However, there has been no comprehensive review on appropriate quality metrics for congenital cardiac anesthesia to date. Members of the Quality and Safety Committee for the Congenital Cardiac Anesthesia Society proposed 31 possible candidate topics for metrics. Using a scoping review strategy, 3649 abstracts were reviewed with 30 articles meeting final criteria. Of these, 5 candidate metrics were unanimously proposed for local collection and national benchmarking efforts: use of a structured handover in the intensive care unit, use of an infection prevention bundle, use of blood conservation strategies, early extubation of cardiopulmonary bypass cases, and cardiac arrest under the care of a cardiac anesthesiologist. Many metrics were excluded due to a lack of primary data and perceived complexity beyond the scope of cardiac anesthesia practice. There is a need to develop more primary data including linking process measures with outcomes, developing risk-stratification for our patients, and collecting national data for benchmarking purposes.

The Spectre of Re-Fencing Off the Public Domain: Italian Copyright and Cultural Heritage Legal Scenarios

Abstract International and European Union (EU) law jointly promote cultural development as a global and cross-border value, mandating national efforts for the preservation, enjoyment, and enhancement of cultural heritage. Cultural development is also the specific objective underlying Art. 14 of the EU Copyright in Digital Single Market Directive (CDSMD), designed to ensure that works of visual arts in the public domain remain a vital source of cultural enrichment across the Union. Against this backdrop, the Italian legal system is currently showing some resistance against such legal obligations. Its transposition of Art. 14 CDSMD explicitly refers to the applicability of the Italian Cultural Heritage Code, which typically requires permission and, in many cases, a fee payment to use reproductions of works of cultural significance, notwithstanding their public domain status. Concurrently, Italian courts have engineered new forms of exclusivity over cultural heritage belonging to the public domain, ignoring copyright law and other applicable norms. The study examines the Italian legal framework on public domain cultural heritage, unveiling a significant degree of incompatibility with international and EU legal obligations. Through a literal, systematic, and teleological legal analysis, the authors unearth how the Italian legal system fails to balance norms regarding cultural heritage, copyright, and data, thus calling for coordinated EU and national interventions towards a sound application of legal rules safeguarding the public domain.

Assessment of the quality and content of clinical practice guidelines for vitamin D and for immigrants using the AGREE II instrument: global systematic review

BackgroundWorldwide, more immigrants experience vitamin D (vitD) deficiency than non-immigrants. Recommendations in current clinical practice guidelines (CPGs) concerning vitD are inadequate to address vitD deficiency among immigrants, and there are...

The Ongoing U.S. Struggle with Maternal Mortality.

Despite significant efforts over the past two decades, the maternal mortality rate (MMR) in the United States remains at least double that of most other high-income countries (HICs). In addition, substantial racial disparities exist with MMRs among Black and American Indian/Alaska Native women two to three times higher than White, Hispanic, and Asian/Pacific Islander counterparts. Of the three surveillance systems currently in place, Maternal Mortality Review Committees (MMRCs) are widely considered to provide the highest quality data. MMRCs in combination with Perinatal Quality Collaboratives and other successful initiatives provide the best hope of reversing these concerning trends. The state of maternal health in the United States is at a critical juncture. To reach the ultimate goal of rendering the United States as one of the "safest countries in the world to give birth" will require greater coordination and consolidation of national efforts across the entire prenatal, perinatal, and postpartum continuum. The authors make suggestions to create a robust federal infrastructure to finally provide equitable high-quality maternal care and bring U.S. maternal mortality into alignment with other HICs. KEY POINTS: · U.S. MMRs are double that of other HICs.. · Black MMRs are two to three times higher than White MMRs.. · "Maternity care deserts" show a marked increase in maternal mortality.. · Listed strategies have shown success in reversing these trends..