Physical Organization Research Articles

Health System Expansion and Changes in Medicare Beneficiary Utilization of Safety Net Providers.

Evidence is limited on insured patients' use of safety net providers as vertically integrated health systems spread throughout the United States. To examine whether market-level health system penetration is associated with: (1) switches in Medicare beneficiaries' usual source of primary care from federally qualified health centers (FQHCs) to health systems; and (2) FQHCs' overall Medicare patient and visit volume. Beneficiary-level discrete-time survival analysis and market-level linear regression analysis using Medicare fee-for-service claims data from 2013 to 2018. A total of 659,652 Medicare fee-for-service beneficiaries aged 65 and older lived in one of 27,386 empirically derived primary care markets whose usual source of care in 2013 was an FQHC or a non-FQHC-independent physician organization that predominantly served low-income patients. Beneficiary-year measure of the probability of switching to health system-affiliated physician organizations and market-year measures of the number of FQHC visits by Medicare beneficiaries, number of beneficiaries attributed to FQHCs, and FQHC Medicare market shares. During 2013-2018, 16.5% of beneficiaries who sought care from FQHCs switched to health systems. When health system penetration increases from the 25th to 75th percentile, the probability of Medicare FQHC patient switching increases by 4.6 percentage points, with 22 fewer Medicare FQHC visits and 4 fewer beneficiaries attributed to FQHCs per market year. Complex patients and patients who sought care from non-FQHC, independent physician organizations exhibited higher rates of switching to health systems. Health system expansion was associated with the loss of Medicare patients by FQHCs, suggesting potential negative spillovers of vertical integration on independent safety net providers.

Climate and Ecosystem Factors Mediate Soil Freeze-Thaw Cycles at the Continental Scale.

Freeze-thaw cycles (FTC) alter soil function through changes to physical organization of the soil matrix and biogeochemical processes. Understanding how dynamic climate and soil properties influence FTC may enable better prediction of ecosystem response to changing climate patterns. In this study, we quantified FTC occurrence and frequency across 40 National Ecological Observatory Network (NEON) sites. We used site mean annual precipitation (MAP) and mean annual temperature (MAT) to define warm and wet, warm and dry, and cold and dry climate groupings. Site and soil properties, including MAT, MAP, maximum-minimum temperature difference, aridity index, precipitation as snow (PAS), and organic mat thickness, were used to characterize climate groups and investigate relationships between site properties and FTC occurrence and frequency. Ecosystem-specific drivers of FTC provided insight into potential changes to FTC dynamics with climate warming. Warm and dry sites had the most FTC, driven by rapid diurnal FTC close to the soil surface in winter. Cold and dry sites were characterized by fewer, but longer-duration FTC, which mainly occurred in spring and increased in number with higher organic mat thickness (Spearman's ⍴=0.97, p<0.01). The influence of PAS and MAT on the occurrence of FTC depended on climate group (binomial model interaction p (χ2)<0.05), highlighting the role of a persistent snowpack in buffering soil temperature fluctuations. Integrating ecosystem type and season-specific FTC patterns identified here into predictive models may increase predictive accuracy for dynamic system response to climate change.

"A fairly good crop for white men:" The political ecology of agricultural science and settler colonialism between the US and Palestine

From 1919 through the early 1950s, agricultural scientists affiliated with the University of California and agricultural scientists setting up settlements in Mandatory Palestine traveled between California and Palestine on a series of research trips. Building on conversations in historical political ecology and critical political ecologies of settler colonialism and racial capitalism, this article sets out to answer: how was agricultural science part of the project of settler colonialism in both California and Palestine in the first half of the twentieth century? Through an analysis of archival materials – field notes, professional and personal correspondence, and scholarly and popular media publications by US and European Jewish Zionist scientists – I argue that these scientists naturalized and made universal racial hierarchies through transnational technoscientific collaboration. US and Zionist scientists engaged in exchange and debate in two topics: the proper physical organization of and location of farms, and; the concept of carrying capacity of the land of historic Palestine. In both, agricultural science was used as an objective reason to elevate Western ideologies of proper cultivation and capitalist yield. This justified the dispossession of Palestinians from their land because they were "poor stewards." This historical case study holds implications for contemporary issues around land and population by Zionists in Israel today, and related debates in global sustainable development at large.

Basic Principles of Physical Education in Strengthening the Child's Body

Physical education of children is necessary for the formation of physically healthy, socially perfect and morally pure people. The rules of organization of physical education of preschool children are analyzed. Information on planning physical education and organization of events in preschool institutions is provided. Physical education classes, including morning hygienic gymnastics, athletics, walks and excursions, as well as dynamic games, diversify the physical education work of children. Correct, accurate and timely implementation of these activities contributes to the comprehensive development of children. Information is given on the feasibility of physical education taking into account the age, gender and physical fitness of children. The article highlights the action of the basic principles for all general education.

Interactions of N- and C-terminal parts of Ana1 permitting centriole duplication but not elongation.

The conserved process of centriole duplication requires establishment of a Sas6-centred cartwheel initiated by Plk4's phosphorylation of Ana1/STIL. Subsequently the centriole undergoes conversion to a centrosome requiring its radial expansion and elongation, mediated by a network requiring interactions between Cep135, Ana1/Cep295, and Asterless/Cep152. Here we show that mutant alleles encoding overlapping N- and C-terminal parts of Ana1 are capable of intragenic complementation to rescue radial expansion. This permits recruitment of Asl and thereby centriole duplication and mechanosensory cilia formation to restore the coordination defects of these mutants. This genetic combination also rescues centriole duplication in the male germ line but does not rescue the elongation of the triplet microtubule-containing centrioles of primary spermatocytes and consequently these males are coordinated but sterile. Such centriole elongation is rescued by the continuous, full-length Ana1 sequence. We define a region that when deleted within otherwise intact Ana1 does not permit primary spermatocyte centrioles to elongate but still allows recruitment of Asl. Our findings point to differing demands upon the physical organization of Ana1 for the distinct processes of radial expansion and elongation of centrioles.

Medicare transitional care management services' association with readmissions and mortality.

In 2013, the Centers for Medicare and Medicaid Services (CMS) introduced codes to reimburse outpatient providers for post-discharge transitional care management (TCM). Understanding the implications of TCM reimbursement on outcomes is crucial for evaluating CMS's investment and guiding future policy. We analyzed the association between physician organization (PO) TCM code use and post-discharge readmissions and mortality using 100% fee-for-service Medicare claims. Using a difference-in-differences approach we compared 1131 "high-TCM" POs (top quartile of TCM code use from 2015-2017) to 1133 "low-TCM" POs (bottom quartile) from before (2012) and after (2015-2017) TCM code implementation, controlling for PO and beneficiary attributes and readmission risk. TCM code use was associated with decreased 30- and 90-day readmissions (-0.31 [95%CI: -0.52, -0.09] and -0.42 [95% CI: -0.71, -0.14] percentage points, respectively), but no significant difference in mortality. Year-by-year, 2017 saw greatest readmission reduction, with a slight mortality reduction in that year only. Readmission reductions were greatest in POs not affiliated with health systems, Accountable Care Organizations (ACOs), or academic medical centers, and least in those with fewer primary care physicians. Narrow, indirect interventions like fee-for-service TCM billing code reimbursement may have limited potential to improve post-discharge outcomes overall. However, small independent practices may derive somewhat greater benefit from this support for post-discharge care.

Evaluation of the hospital emergency plan based on an exercise for a mass casualty incident

The hospital emergency plan is an important tool for hospitals in the management of amass casualty incident. It is alegal requirement for hospitals to have such plans in place and to carry out drills. Emergency drills are auseful tool for the training of staff and for the evaluation of existing structures. The emergency plan of the University Hospital Würzburg (UKW) was evaluated during adisaster drill based on predefined drill objectives. The procedures according to the emergency plan of the UKW were practiced during alarge-scale disaster exercise. The exercise objectives were defined as: testing the management structure, deployment of personnel, physical organization, triage, patient flow and communication. Several exercise objectives were defined in advance. An anonymized questionnaire was used to evaluate the achievement of the exercise objectives. When properly trained and practiced the UKW emergency plan is generally well-suited to managing amass casualty event. Improvements need to be made in the communication structure, responsibilities in the treatment areas and staff knowledge of the existing emergency plans and available material. Mass casualty drills are agood tool for the evaluation of hospital emergency plans. Acritical and decisive element for success is the existence of aclear management and communication structure. Agood knowledge of the available material, the contents of the emergency plan and the consistent application of the procedures defined in this plan are essential for acoordinated course of action. This can be achieved by means of regular and mandatory training sessions.

The Michigan Collaborative for Type 2 Diabetes (MCT2D): Development and implementation of a statewide collaborative quality initiative

BackgroundType 2 diabetes (T2D) is one of the most prevalent chronic diseases worldwide and a leading cause of cardiorenal disease and mortality. Only one-third of individuals with T2D receive care as recommended by the American Diabetes Association’s clinical practice guidelines. Effective strategies are needed to accelerate the implementation of guideline concordant T2D care.MethodsThe Michigan Collaborative for Type 2 Diabetes (MCT2D) is a statewide population health collaborative quality initiative (CQI) developed to improve the care of all people with T2D in Michigan. MCT2D has developed a learning health system with physician organizations and their constituent practices to support quality improvement initiatives focused on (1) improving use of guideline-directed pharmacotherapy to improve cardiorenal outcomes, (2) increasing evidence-based use of continuous glucose monitoring, and (3) supporting use of lower carbohydrate eating patterns.ResultsBetween 2021 and 2022, MCT2D recruited 28 of the 40 Michigan-based physician organizations participating in Blue Cross’ Physician Group Incentive Program with 336 constituent practices and 1357 physicians in primary care (304), endocrinology (21) and nephrology (11). In January 2022, baseline data included a sample of 96,140 unique individuals with T2D. The baseline HbA1c was ≤ 7.0% for 66.3% of patients (n = 32,787), while 14.9% of patients had a most recent HbA1c ≥ 8.0% (n = 7,393). The most recent body mass index (BMI) was ≥ 30.0 for 64.8% of patients (n = 38,516).DiscussionMCT2D has organized a statewide collaborative to recruit and engage a diverse and large set of physician organizations and their constituent practices. This is a promising opportunity to accelerate adoption of guideline-concordant care for people with T2D and may be a model for other state or regional collaboratives. Future directions include specific evidence-based interventions targeted at reducing diabetes-linked comorbidities and associated healthcare costs as well as strategies focused on T2D prevention among at-risk populations.

Identifying psychosocial and contextual markers considered by physicians to personalize care

BackgroundThe objective of the study was to identify the psychosocial and contextual markers considered by physicians to personalize care.MethodsAn online questionnaire with one open-ended question, asking physicians to describe clinical situations in which they personalized care, was used. Physicians were recruited from March 31, 2023, to August 10, 2023, from three hospitals, five university departments of general practice and six physician organizations in France. Recruitment was conducted through email invitations, with participants encouraged to invite their colleagues via a snowball sampling method. The participants were a diverse sample of French general practitioners and other medical specialists who see patients in consultations or in hospital wards. We extracted the psychosocial and contextual markers considered by physicians to personalize care in each clinical situation. The analysis involved both manual and AI-assisted content analysis using GPT3.5-Turbo (OpenAI). Mathematical models to assess data saturation were used to ensure that a comprehensive list of markers was identified.ResultsIn total, 1340 people connected to the survey platform and 1004 (75.0%) physicians were eligible for the study (median age 39 years old, IQR 34 to 50; 60.5% women; 67.0% working in outpatient settings), among whom 290 answered the open-ended question. The participants reported 317 clinical situations during which they personalized care. Personalization was based on the consideration of 40 markers: 27 were related to patients’ psychosocial characteristics (e.g., patient capacity, psychological state, beliefs), and 13 were related to circumstances (e.g., competing activities, support network, living environment). The data saturation models showed that at least 97.0% of the potential markers were identified. Manual and AI-assisted content analysis using GPT3.5-Turbo were concordant for 89.9% of clinical situations.ConclusionsPhysicians personalize care to patients’ contexts and lives using a broad range of psychosocial and contextual markers. The effect of these markers on treatment engagement and effectiveness needs to be evaluated in clinical studies and integrated as tailoring variables in personalized interventions to build evidence-based personalization.

Global organization of phenylpropanoid and anthocyanin pathways revealed by proximity labeling of trans-cinnamic acid 4-hydroxylase in Petunia inflata petal protoplasts.

The phenylpropanoid pathway is one of the main carbon sinks in plants, channeling phenylalanine towards thousands of products including monolignols, stilbenes, flavonoids and volatile compounds. The enzymatic steps involved in many of these pathways are well characterized, however the physical organization of these enzymes within the plant cell remains poorly understood. Proximity-dependent labeling allows untargeted determination of both direct and indirect protein interactions in vivo, and therefore stands as an attractive alternative to targeted binary assays for determining global protein-protein interaction networks. We used TurboID-based proximity labeling to study protein interaction networks of the core phenylpropanoid and anthocyanin pathways in petunia. To do so, we coupled the endoplasmic reticulum (ER) membrane anchored cytochrome P450 cinnamic acid 4-hydroxylase (C4H, CYP73A412) from Petunia inflata to TurboID and expressed it in protoplasts derived from anthocyanin-rich petunia petals. We identified multiple soluble enzymes from the late anthocyanin pathway among enriched proteins, along with other C4H isoforms, and other ER membrane anchored CYPs. Several of these interactions were subsequently confirmed by bimolecular fluorescence complementation (BiFC). Our results suggest that C4H co-localizes with enzymes from the phenylpropanoid- and downstream anthocyanin pathways, supporting the idea that C4H may serve as ER anchoring points for downstream metabolic pathways. Moreover, this study demonstrates the feasibility of using protoplasts to perform global mapping of protein network for enzymes in their native cellular environment.

The impact of the indoor home environment on children's prosocial behaviour

Although the role of the home environment in the development of prosocial behaviour in childhood is well-established, the existing research has focused on the emotional microclimate of the home. We do not know whether the physical home environment has a role to play too. The present study aims to fill this gap. It uses data from a large, nationally representative birth cohort survey in the UK, tracking the trajectories of prosocial behaviour in children across ages 3, 5, 7 and 11 years as a function of three constructs derived from the Home Observation Measurement of the Environment Short Form (HOME-SF), assessed at age 3 years: physical organisation of the home, mother's emotional and verbal responsivity, and mother's use of harsh discipline. Prosocial behaviour was assessed via a parent-reported subscale of the Strengths and Difficulties Questionnaire. The findings, which were robust to adjustment for sex, ethnicity, cognitive ability, special educational needs, neighbourhood environment, family income, family structure, maternal mental health, maternal education and religiosity, showed that all three aspects of the home environment were associated with prosocial behaviour. However, when controlling for all three simultaneously, physical organisation ceased to be a significant predictor of prosocial behaviour although the two measures of the home's emotional environment retained their significance. This indicates that, compared to the physical, the emotional climate of the home has a more substantial impact on children's prosocial behaviour. It also suggests that the physical and the emotional context of the home are strongly interrelated, with aspects of emotional harshness possibly mediating the effects of the home's physical disorganisation.

Chemical Programming of Solubilizing, Nonequilibrium Active Droplets.

ConspectusThe multifunctionality and resilience of living systems has inspired an explosion of interest in creating materials with life-like properties. Just as life persists out-of-equilibrium, we too should try to design materials that are thermodynamically unstable but can be harnessed to achieve desirable, adaptive behaviors. Studying minimalistic chemical systems that exhibit relatively simple emergent behaviors, such as motility, communication, or self-organization, can provide insight into fundamental principles which may enable the design of more complex and life-like synthetic materials in the future.Emulsions, which are composed of liquid droplets dispersed in another immiscible fluid phase, have emerged as fascinating chemically minimal materials in which to study nonequilibrium, life-like properties. As covered in this Account, our group has focused on studying oil-in-water emulsions, specifically those which destabilize by solubilization, a process wherein oil is released into the continuous phase over time to create gradients of oil-filled micelles. These chemical gradients can create interfacial tension gradients that lead to droplet self-propulsion as well as mediate communication between neighboring oil droplets. As such, oil-in-water emulsions present an interesting platform for studying active matter. However, despite being chemically minimal with sometimes as few as three chemicals (oil, water, and a surfactant), emulsions present surprising complexity across the molecular to macroscale. Fundamental processes governing their active behavior, such as micelle-mediated interfacial transport, are still not well understood. This complexity is compounded by the challenges of studying systems out-of-equilibrium which typically require new analytical methods and may break our intuition derived from equilibrium thermodynamics.In this Account, we highlight our group's efforts toward developing chemical frameworks for understanding active and interactive oil-in-water emulsions. How do the chemical properties and physical spatial organization of the oil, water, and surfactant combine to yield colloidal-scale active properties? Our group tackles this question by employing systematic studies of active behavior working across the chemical space of oils and surfactants to link molecular structure to active behavior. The Account begins with an introduction to the self-propulsion of single, isolated droplets and how by applying biases, such as with a gravitational field or interfacially adsorbed particles, drop speeds can be manipulated. Next, we illustrate that some droplets can be attractive, as well as self-propulsive/repulsive, which does not fall in line with the current understanding of the impact of oil-filled micelle gradients on interfacial tensions. The mechanisms by which oil-filled micelles influence interfacial tensions of nonequilibrium interfaces is poorly understood and requires deeper molecular understanding. Regardless, we extend our knowledge of droplet motility to design emulsions with nonreciprocal predator-prey interactions and describe the dynamic self-organization that arises from the combination of reciprocal and nonreciprocal interactions between droplets. Finally, we highlight our group's progress toward answering key chemical questions surrounding nonequilibrium processes in emulsions that remain to be answered. We hope that our progress in understanding the chemical principles governing the dynamic nonequilibrium properties of oil-in-water droplets can help inform research in tangential research areas such as cell biology and origins of life.

Climate change impacts on a sedimentary coast—a regional synthesis from genes to ecosystems

Climate change effects on coastal ecosystems vary on large spatial scales, but can also be highly site dependent at the regional level. The Wadden Sea in the south-eastern North Sea is warming faster than many other temperate coastal areas, with surface seawater temperature increasing by almost 2 °C over the last 60 years, nearly double the global ocean mean increase. Climate warming is accompanied by rising sea levels, which have increased by approximately 2 mm yr−1 over the last 120 years. For this sedimentary coast, the predicted acceleration of sea-level rise will have profound effects on tidal dynamics and bathymetry in the area. This paper synthesises studies of the effects of ocean warming and sea level rise in the northern Wadden Sea, largely based on research conducted at the Wadden Sea Station Sylt of the Alfred Wegener Institute Helmholtz Centre for Polar and Marine Research. An increasing rate of sea level rise above a critical threshold will lead to coastal erosion and changes in sediment composition, and may cause the transition from a tidal to lagoon-like environment as tidal flats submerge. This involves changes to coastal morphology, and the decline of important habitats such as muddy tidal flats, salt marshes and seagrass meadows, as well as their ecological services (e.g. carbon sequestration). Ocean warming affects plankton dynamics and phenology, as well as benthic community structure by hampering cold-adapted but facilitating warm-adapted species. The latter consist mostly of introduced non-native species originating from warmer coasts, with some epibenthic species acting as ecosystem engineers that create novel habitats on the tidal flats. Warming also changes interactions between species by decoupling existing predator–prey dynamics, as well as forming new interactions in which mass mortalities caused by parasites and pathogens can play an understudied but essential role. However, Wadden Sea organisms can adapt to changing abiotic and biotic parameters via genetic adaptation and phenotypic plasticity, which can also be inherited across generations (transgenerational plasticity), enabling faster plastic responses to future conditions. Important research advances have been made using next-generation molecular tools (-omics), mesocosm experiments simulating future climate scenarios, modelling approaches (ecological network analysis), and internet-based technologies for data collection and archiving. By synthesising these climate change impacts on multiple levels of physical and biological organisation in the northern Wadden Sea, we reveal knowledge gaps that need to be addressed by future investigations and comparative studies in other regions in order to implement management, mitigation and restoration strategies to preserve the uniqueness of this ecosystem of global importance.

Clinician Knowledge and Attitudes About Climate Change and Health After a Quality Incentive Program

Climate change is a fundamental threat to human health, and industries, including health care, must assess their respective contribution to this crisis. To assess the change in knowledge of clinicians who completed a quality incentive program (QIP) measure on climate change and health care sustainability and to examine clinician attitudes toward climate change and their perception of clinical and individual relevance. The participants in this survey study included employed physicians and psychologists who were part of a hospital physician organization in an academic medical center (AMC) in Boston, Massachusetts. The hospital physician organization provides a QIP with different measures every 6 months and provides incentive payments on completion. The study is based on a survey of participants on completion of a QIP measure focused on climate change and health care sustainability offered from July 2023 through September 2023 at the AMC. Structured educational video modules. After completion of the modules, the participants reported their baseline and postintervention knowledge on climate change impacts on health and health care sustainability, perceived relevance of the material, and attitudes toward the modules using 5-point Likert scales and free-text comments. Data were analyzed using univariate and multivariable analyses including participant age, gender, and practice specialty. Of the 2559 eligible clinicians, 2417 (94.5%) (mean [SD] age, 48.9 [11.5] years; range, 29-85 years; 1244 males [51.5%]) participated in the measure and completed the survey. Among these participants, 1767 (73.1%) thought the modules were relevant or very relevant to their lives and 1580 (65.4%) found the modules relevant or very relevant to their clinical practice. Age was not associated with responses. Practitioners in specialties classified as climate facing were more likely to think that the education was relevant to their clinical practice compared with those in non-climate-facing specialties (mean [SD] score, 3.76 [1.19] vs 3.61 [1.26]; P = .005). Practitioners identifying as female were also more likely to consider this education as relevant to their clinical practice compared with male practitioners (mean [SD] score, 3.82 [1.17] vs 3.56 [1.27]; P < .001). In this survey study, a high proportion of clinicians expressed positive attitudes toward education in climate change and health and health care sustainability, with some demographic and specialty variability. These data support that climate and health education in AMCs provides information that practitioners see as relevant and important.

Central Association of Obstetricians and Gynecologists Conference Abstracts - 2023

The Central Association of Obstetricians and Gynecologists is a nonprofit organization of physicians that encourages and promotes the study of Obstetrics and Gynecology and Women’s Health Care. Member physicians represent nearly 500 physicians from 43 states. Each year, the Central Association (CAOG) hosts an annual meeting that updates member physicians about current medical advances.

Pandemic Impact, Support Received, and Policies for Health Worker Retention: An Environmental Scan.

The COVID-19 pandemic has brought additional strain to health workers in the Philippines, leading to a significant proportion of them leaving the workforce. The purpose of this study is to explore the impact of the pandemic on health workers, the support that they received and associated challenges; and identify relevant policies for better workplace conditions. An environmental scanning method was utilized. Particularly, a literature review and policy scan that were validated through key informant interviews with administrators and frontline health workers from selected urban and rural sites in the three main islands in the Philippines. These were framed into a background note to springboard the discussions during a national policy dialogue participated by representatives from key government organizations, professional organizations of physicians, nurses, and midwives, professional regulatory bodies, hospital administrators, frontline health workers, and donor agencies in the Philippines. Deaths, burn-out, mental health problems, lack of personal protective equipment and poor allocation of vaccines were reported in the early phases of the pandemic. Support varied across settings but included additional allowance, free meals, accomodation, transportation, training and psychosocial services. Furthermore, pre-pandemic issues such as as low salaries and heavy workload continue to be the main reasons for leaving the workforce or the country. The proposed solutions are as follows: (1) creating policies and strategies for appropriate production, recruitment, and retention of human resources for health; (2) allocating regular permanent positions for both the education and health sector; (3) augmenting and continuation of deployment programs; (3) expanding roles of nurses to push for advanced practice nursing; (4) providing fair compensation along with risk allowances, non-financial incentives, and expanded benefits; (5) supporting mental health wellness by providing an appropriate work-rest balance and safe work environment; (6) providing opportunities for professional development and scholarships with accompanying return-service agreement; and (7) strengthening the reintegration programs for returning overseas health workers. The pandemic has affected the well-being of health workers and disparities in support were reported due to longstanding workplace issues and policy implementation gaps. Stakeholder commitments require sustained monitoring while policies that are in place and yet to be developed demand stronger support from the government, members of Congress, the private sector, and other key decision-makers.

Sharps injuries among healthcare workers in Liberia and Ghana: a cross-sectional survey.

There are little data on sharps injuries among healthcare workers in West Africa despite the region's high rate of hepatitis B and human immunodeficiency virus. The purpose of this study is to investigate healthcare workers' history of sharps injuries in Liberia and Ghana. An electronic cross-sectional survey was conducted among healthcare workers in Liberia and Ghana from February to June 2022. A link to the survey was texted to participants through professional association membership lists, including nursing, midwifery, and physician assistant organizations in both Liberia and Ghana and a physician organization in Ghana only. Five hundred and nine participants reported an average of 1.8 injuries per year in Liberia and 1.1 in Ghana (P ≤ .01); 15.1% of healthcare workers reported three or more injuries in the past year. Liberia had a higher proportion of frequently injured workers (P = .01). Frequently injured workers were evenly distributed across worker types. Workers in this region are vulnerable to sharps injuries. A frequently injured subset of workers likely has distinctive risk factors and would benefit from further investigation and intervention.

Военизация физической культуры и спорта в 1920-е годы:способы организации, итоги

The military reform of the Armed Forces of the Soviet Union in 1924–1925 was aimed at improving leadership and improving the quality of training of command personnel, creating a new system for recruiting the Armed Forces, and organizing a coherent system for military service by the country's citizens. Physical education organizations were tasked with militarizing physical culture and sports and solving the problem of military physical training of pre-conscription youth. Based on materials from the central and regional periodicals of the pre-war period, the article presents the methods and forms of militarization in the European North of the Soviet Union. The novelty of the study is determined by the fact that the work is the first to analyze the problems of the development of physical education and sports in the light of the policy of militarization in the northern regions of the country. The author proves that in the 1920s this direction was at the initial stage of its development, limited to agitation and propaganda among the population and holding demonstration sports competitions in certain sports.

МЕТОДОЛОГИЯ КЛИНИЧЕСКИХ АУДИТОВ ОТДЕЛЕНИЙ ЛУЧЕВОЙ ТЕРАПИИ В РФ НА ОСНОВЕ ПРИНЦИПОВ АУДИТА МАГАТЭ QUATRO

Purpose: To describe the essence, tasks and algorithm of comprehensive audit in radiotherapy departments of medical institutions in Rus sian Federation. The methodology of audits conducted by the International Atomic Energy Agency (IAEA) and adapted for its further application, was used as a model. The global goal of the audit project is to standardize and harmonize procedures to ensure safety and quality control of treatment of cancer patients in different institutions, to enable comparison of radiation therapy results among participating institutions, to conduct interclinical studies and, possibly, to create a unified data register. Material and methods: One of the main aspects of clinical audits is the harmonization of standards between different departments. Clinical audits in radiotherapy can be an important tool for interclinical quality assurance (QA) program, effectiveness and safety of radiotherapy, and treatment protocols synchronization. Audits allow an in-depth analysis of the procedures and processes governing patient care in a particular clinic. Such clinical audits cover the whole chain of patients care, the organization of structural units, the infrastructure, clinical, physics and technical aspects underlying the radiotherapy department. This audit is a peer review process conducted by an audit team consisting of a radiation oncologist (RO), medical physicist (MP) and radiation technologist (RTT) and is known as QUATRO and stands for Quality Assurance Team in Radiation Oncology). Possible audit tools include: 1. Saff interviewing. 2. Examination of the structure of the entire department. 3. Review and evaluation of procedures and all relevant documentation, including analysis of patient charts. 4. Conducting independent measurements of absorbed doses and other methods of local procedures monitoring, where relevant and appropriate. 5. Observation of the practical implementation of operating procedures. Results: It was decided to use the IAEA QUATRO methodology for clinical audits and to adapt it to the specifics of radiotherapy in Russian Federation. One of the advantages of such a clinical audit is that the formalism and algorithm of this approach will be identically applied in all departments, which will allow comparing and analyzing the results. In order to obtain structured information, a detailed research protocol, which is a questionnaire, has been developed. The questions in the questionnaire allow to assess key aspects of the radiotherapy process that affect clinical outcomes and treatment efficiency.

A Hybrid Escape Room to Foster Motivation and Programming Education for Pre-Service Teachers

Educational escape rooms aims to motivate students, to strengthen knowledge and evaluate learning. Pre-service teachers enrolled in “Computer Science and Digital Competency” course shows lack of motivation and difficulties to realise its usefulness in everyday practice, becoming an ideal context to apply this strategy. 157 students belonging to a European university participated in the experience as case study. The educational escape room was conducted following a hybrid model, mixing a physical organization of props with a virtual organization of the narrative, tests and achievements. The experiment was designed to answer two hypotheses, first if applying escape room as an educational strategy fosters pre-primary and primary students' motivation, since this method address complex concepts in a practical way, and second, if the application of this strategy as teaching strategy makes students perceive the learning process as a game.