Relative Positioning Research Articles

Is the positioning guide mandatory for the virtual planning of orthognathic surgery? A randomized double-blind trial.

The aim of this study is to verify the positioning of the condyles in computed tomography (CT) scans of skeletal Class II and Class III patients in virtual surgical planning before orthognathic surgery. The secondary aim is to determine whether occlusal devices are mandatory for performing a CT examination. In this retrospective randomized double-blind study, 42 CT scans were evaluated from patients who had undergone to orthognathic surgery at the University Hospital of the University of São Paulo. Male and female patients between the ages of 25 and 40 were included. The sample consisted of skeletal Class II and III patients. The CTs were randomly selected into centric relation (CR) and maximal intercuspal position (MI). Statistical analysis was performed with R Statistical Package and was considered significant in the case of p <0.0001. A total of 504 measurements were carried out in 42 patients. Three joint spaces on each side were used. No statistically significant difference between the inter- and intraobservers was found for CR and MI. Some scores were performed to avoid the risk of gender bias. No statistically significant value was found between patients in CR and MI after mandibular manipulation. The use of a positioning guide to perform a CT scan prior to virtual planning is not absolutely necessary.

The Geopolitics of Water Infrastructure on the Kinmen Islands

ABSTRACT This paper examines the bordering and debordering deployment of water infrastructures on the Islands of Kinmen. Located less than 5 km off the coast of China, yet 200 km from their governing authority, Taiwan, Kinmen holds a critical position in cross-strait relations, and its water infrastructures have carried opposite political intentions. The 2018 Fujian-Kinmen water transfer pipeline serves as a debordering tool as it showcases that the People’s Republic of China could offer benefits to the people on the islands. In contrast, Kinmen’s existing water infrastructure, established during the Cold War, served as part of the bordering campaign to counter Communist China, as it represented progress and modern living under the government of the Republic of China (Taiwan). However, rather than assuming the successful deployment of infrastructure or a passive role of the islands, this paper highlights that the planning and construction of Kinmen’s water infrastructures were influenced by conditions of militarisation, shifting cross-strait relations, the islands’ socio-material constraints and their relationships with Taiwan and China. The case of Kinmen illustrates the capacity of water infrastructure to serve bordering and debordering purposes, as well as how other factors disrupt or facilitate these processes.

Impact of Stabilization Splint Therapy on Orthodontic Diagnosis in Patients with Signs and Symptoms of Temporomandibular Disorder.

The relation between the orthopedic temporomandibular joint (TMJ) instability and temporomandibular disorder (TMD) most commonly remain unrecognized by orthodontists. In this study we aimed to evaluate the dentofacial characteristics and temporomandibular disorder symptomatology of patients with orthopedic instability before and after deprogramming with a stabilization splint. Sixty patients with the signs and symptoms of TMD were assessed using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and underwent stabilization splint therapy to place the condyles in a more stable musculoskeletal position. The extent of condylar displacement was evaluated using the condylar position indicator (CPI). Sixteen angular and linear hard tissue landmarks were traced and compared from lateral cephalograms taken in the maximum intercuspation (MI) position before, and in the centric relation (CR) position after, the splint therapy. Following the splint therapy, the signs and symptoms of TMD were significantly reduced or completely eliminated in more than 90% of patients. Compared with the values registered before the splint therapy, a significant reduction in the mean values of condylar displacement was observed on both sides of the vertical (p < 0.001), horizontal (p < 0.05), and transverse (p < 0.001) planes of space after the splint therapy. A comparison of pre- and post-splint lateral cephalograms revealed that, following the splint therapy, the mandible moved more posteriorly and rotated in a more clockwise direction. In patients with orthopedic instability and the signs and symptoms of TMD, muscle deprogramming with a stabilization splint therapy is highly recommended to improve the health of the temporomandibular joint and masticatory structures and contribute to a more correct orthodontic diagnosis.

The EU’s longer arm abroad: the role of EU Delegations in crisis management

ABSTRACT Since the establishment of the EEAS as the EU’s diplomatic service and the transformation of the EU’s representation abroad into EU Delegations, the EU has been a pioneer in multilateral diplomacy and contributed to development in its wider neighbourhood. These bodies made a significant contribution to widening the EU’s diplomatic network and strengthening its position in foreign policy and external relations. However, EU Delegations play a minimal role in the EU’s crisis management efforts despite their presence on the ground and their useful recourses, which could, in fact, provide crucial assets to EU-led missions. While the EU has shown successes in diplomacy, its Delegations face the problems of multiple principals and non-exclusive delegation which risk undermining the EU’s overall capacities as a global actor. This article applies the PA model to illustrate these dual problems in the cases of the CSDP missions conducted in Mali and Ukraine.

Progressive heterogeneity of enlarged and irregularly shaped apicoplasts in P. falciparum persister blood stages after drug treatment.

Morphological modifications and shifts in organelle relationships are hallmarks of dormancy in eukaryotic cells. Communications between altered mitochondria and nuclei are associated with metabolic quiescence of cancer cells that can survive chemotherapy. In plants, changes in the pathways between nuclei, mitochondria, and chloroplasts are associated with cold stress and bud dormancy. Plasmodium falciparum parasites, the deadliest agent of malaria in humans, contain a chloroplast-like organelle (apicoplast) derived from an ancient photosynthetic symbiont. Antimalarial treatments can fail because a small fraction of the blood stage parasites enter dormancy and recrudesce after drug exposure. Altered mitochondrial-nuclear interactions in these persisters have been described for P. falciparum, but interactions of the apicoplast remained to be characterized. In the present study, we examined the apicoplasts of persisters obtained after exposure to dihydroartemisinin (a first-line antimalarial drug) followed by sorbitol treatment, or after exposure to sorbitol treatment alone. As previously observed, the mitochondrion of persisters was consistently enlarged and in close association with the nucleus. In contrast, the apicoplast varied from compact and oblate, like those of active ring stage parasites, to enlarged and irregularly shaped. Enlarged apicoplasts became more prevalent later in dormancy, but regular size apicoplasts subsequently predominated in actively replicating recrudescent parasites. All three organelles, nucleus, mitochondrion, and apicoplast, became closer during dormancy. Understanding their relationships in erythrocytic-stage persisters may lead to new strategies to prevent recrudescences and protect the future of malaria chemotherapy.

Constructing ethnic consciousness: the role of cultural heritage in Malaysia

ABSTRACT The Chinese community’s unique position in Malaysian inter-ethnic relations weaves through intricate interactions with other ethnic groups, maintaining distinct cultural identities amidst Malaysia’s diverse ethnic fabric. This study explores the intricate relationship between ethnic consciousness and cultural heritage among Malaysian Chinese people, examining, within a historical context, how this community maintains its distinct identity within a multi-ethnic society. Utilizing focus group discussions (FGDs) with Chinese independent schools (CIS) students, the study delves into their identity perceptions, influenced by both “authority-defined” and “everyday-defined” social realities. The findings reveal how cultural heritage, particularly through lion dance activities, reinforces ethnic consciousness while contributing to a broader national identity. This study elucidates the complex dynamics of ethnic identity formation in a multicultural context and advocates for an inclusive heritage management. Such an approach fosters dialogue, respects diversity, and enhances our understanding of the role of heritage in shaping a cohesive, multicultural society.

Dirac Theory in Noncommutative Phase Spaces

Based on the position and momentum of noncommutative relations with a noncanonical map, we study the Dirac equation and analyze its parity and time reversal symmetries in a noncommutative phase space. Noncommutative parameters can be endowed with the Planck length and cosmological constant such that the noncommutative effect can be interpreted as an effective gauge potential or a (0,2)-type curvature associated with the Plank constant and cosmological constant. This provides a natural coupling between dynamics and spacetime geometry. We find that a free Dirac particle carries an intrinsic velocity and force induced by the noncommutative algebra. These properties provide a novel insight into the Zitterbewegung oscillation and the physical scenario of dark energy. Using perturbation theory, we derive the perturbed and nonrelativistic solutions of the Dirac equation. The asymmetric vacuum gaps of particles and antiparticles reveal the particle–antiparticle symmetry breaking in the noncommutative phase space, which provides a clue to understanding the physical mechanisms of particle–antiparticle asymmetry and quantum decoherence through quantum spacetime fluctuation.

A Study of the Body Narrative in the Film Portrait de la Jeune Fille en Feu from a Feminist Perspective

This article analyses the body narrative in the film Portrait de la Jeune Fille en Feu from a feminist perspective, exploring the gendered power structures implicit in the female characters' bodily expressions and discussing how it constructs and reflects feminist theories. The article reviews the development of feminist theory, emphasises the importance of body narrative theory and its application in film studies, and chooses the film Portrait de la Jeune Fille en Feu as the object of study. Through textual analysis and feminist critical theory, this study dissects the body narratives of the female characters to reveal how visual language and symbols shape the body's position in gendered power relations. It is found that the female body narratives in the film are not only an expression of subjectivity, but also a response to social power structures, demonstrating the deep connection between gender, power and self-identity.

Orientation on internal customer satisfaction in public administration

In the modern world, there is a constant increase in the role and importance of the customer who is achieving a dominant position in mutual relations in the organization. The situation is also noticeable in the public administration sector, where activities related to improving the functioning of the office, customer service and customer satisfaction are an important element of the development. The subject of the article is the analysis of the internal customer's opinion as an expression of building an orientation focused on the customer’s satisfaction in the public administration sector. The aim is to present the surveys on internal customer satisfaction that were conducted within the years 2012-2021 in a selected public administration unit. The conceptual basis of the terms public administration as well as the external and internal customer was also presented. The results of the research over the years and their discussion have been presented in the conclusion. The considerations undertaken in the elaboration lead to the conclusion that the orientation towards internal customer satisfaction in public administration is justified because it ultimately affects the level of public services provided, the quality of which is guaranteed, among others, by: stable and job-satisfied staff.

Bivariate scoring rules: Unifying the characterizations of positional scoring rules and Kemeny's rule

This paper studies social preference functions (SPFs), which map the voters' ordinal preferences over a set of alternatives to a non-empty set of strict rankings over the alternatives. Maybe the most prominent SPFs are positional scoring rules and Kemeny's rule. While these two types of rules behave intuitively quite differently, they are axiomatically surprisingly similar and we thus provide a joint axiomatic characterization of these SPFs. To this end, we introduce the class of bivariate scoring rules which generalize Kemeny's rule by weighting comparisons between alternatives depending on their positions in the voters' preference relations. In particular, this class contains both Kemeny's rule and all positional scoring rules. As our main result, we then characterize the set of bivariate scoring rules as the only SPFs that satisfy—aside from some standard axioms—mild consistency conditions for variable electorates and variable agendas. As corollaries of this result, we also derive variants of the well-known characterizations of positional scoring rules by Smith (1973) and of Kemeny's rule by Young (1988). Thus, our result unifies the independent streams of research on positional scoring rules and Kemeny's rule by giving a joint axiomatic basis of these SPFs.

Evaluation of the External Soft Tissue Changes Following the Correction of Class II Skeletal Malocclusion in the Adolescence Period Using Removable and Fixed Functional Appliances: A Systematic Review and Meta-Analysis.

In this systematic review, we aimed to assess the current evidence regarding the effectiveness of functional treatment with both removable and fixed appliances to normalize the external soft tissue for skeletal class II adolescent individuals. We performed a broad electronic search to retrieve relevant studies from nine databases to identify randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that investigated soft tissue changes following functional treatment and evaluated the changes using 2D lateral cephalometric radiographsand 3D-optical surface laser scanning. A total of three RCTs and eight CCTs were included. Ages ranged from 11 to 16 years with the fixed functional appliances, and from eight to 12 years with the removable ones, including 689 skeletal class II patients. Version 2 of Cochran's risk-of-bias (RoB2), and the risk of bias in non-randomized studies of interventions (ROBIN-I) were used to assess the risk of bias for the included papers. Of the 11 eligible studies, three studies were included in the meta-analysis to assess the upper and lower lip position in relation to the E-line (Ricketts's aesthetic line) in addition to the nasolabial angle. The meta-analysis showed that the upper lip retracted after functional treatment with Twin-block in relation to E-line (mean difference (MD) = -1.93; 95% CI: -2.37, -1.50; p < 0.00001; χ² = 5.43; p = 0.07; I2 = 63%), while the lower lip position did not change after functional treatment with Twin-block in relation to E-line (MD = 0.03; 95% CI: -0.56, 0.61; p = 0.92; χ² = 1.74; p = 0.42; I2 = 0%). The nasolabial angle increased after Twin-block treatment (MD = 5.75; 95% CI: 4.57, 6.93;p < 0.00001; χ² = 6.77; p = 0.03; I2 = 70%). The mentolabial angle and Z-angle also increased after functional therapy, where the facial convexity angle decreased, regardless of the functional devices used. On the other hand, using the 3D-optical surface laser scanning showed that the upper lip length and the commissural width did not change following therapy, but the lower lip increased in length, as well as the total face height. More high-quality RCTs are required to obtain accurate evidence in this field.

Different methods of determining centric relation – comparison with a digital mandibular motion analyser

BackgroundFinding and registering the maxillary–mandibular jaw relation is crucial in dental practice. Several comparative studies have been conducted to investigate the reproducibility and accuracy of techniques for determining the centric relation (CR) position of the mandible. The aim of our study was to determine which of seven different CR determination methods had the smallest deviation from the theoretical zero with the help of a digital mandibular motion analyser. The chosen theoretical zero position, the maximal intercuspal position (MIP), is the most reproducible and widely used position.MethodsThirty-four volunteers (24 females and 10 males) with a mean (SD) age of 29.1 (± 7.3) years with a negative history of temporomandibular disorder (TMD) participated in the study. A digital mandibular motion analyser was used to register the condylar position after the use of each technique for the determination of CR. The calibration was performed to the maximal intercuspal position (MIP) for each volunteer. The investigated techniques were (A) the gothic arch tracer, (B) the adduction field method, (C) Dawson’s bimanual manipulation, (D) the patient placing the tongue tip on the palatal rugae, (E) the patient placing the tongue tip to the border of the hard and soft palate, (F) the patient actively pulling the chin backwards, and (G) the examiner pushing the patient’s chin back.ResultsThe position of the mandibular condyle was illustrated in a three-dimensional coordinate system, where the origin represented the MIP. Among the seven methods examined, five showed significant deviations compared to the MIP. Among these, two methods resulted in posterior deviation of the condyles. Methods C and E coincided with the MIP in all directions.ConclusionsWithin the limitations of our study, we found that the smallest deviations from our theoretical zero (MIP) among the investigated centric relation determining methods were obtained with the bimanual mandibular manipulation technique derived from Dawson and the placement of the tongue tip on the border of the hard and soft palate (linguomandibular homotrophy theory).

Khanty urban women in the second half of the 20th — early 21st century: continuity of ethnocul-tural traditions, a view from the “inside”

Ethnicity is a dynamic category based on ethnic background. Most clearly it is expressed in the traditional environment, natural for the preservation of cultural traditions, which is associated with ancestral places, rural areas. In recent years, the number of representatives of indigenous peoples of the North living in the cities of Yugra has increased significantly. The main force of national intelligentsia is concentrated in the city of Khanty-Mansiysk, public institutions have been created there that became a part of the modern ethnic culture of the Ob Ugrians. The most representative part of this community are women, they clearly show their creative nature. The purpose of this work is to capture the features of the expression of ethnicity among Khanty women of different generations living in urban conditions, to trace its changes and continuity using the example of resi-dents of Khanty-Mansiysk. To assess this topic, a “look from the inside” is characteristic, the author places herself in the center of the study, as she belongs to this community. The stories of famous Khanty women who were born in the 1930s in a traditional environment but became citizens, as well as stories of their daughters and granddaughters born in the city, serve as a “refe-rence”. The author concludes on the natural “blurring” of ethnic identity in city environment. This is a natural process caused by the environment itself, as well as by metisation of urban residents. The process of assimilation of ethnic cultures in urban condi-tions is faster. The “true” representatives of traditional culture in urban environment are those born in rural areas. The first gen-eration of urban women (“mothers”) keeps in touch with the traditional environment, usually speaks their native language and appears as representatives of ethnic culture. The second generation (“daughters”) takes a marginal position in relation to their native culture and the urbanized environment, they are able to perceive their native culture, but at a different level; they rather carry a universal identity. Representatives of the third generation (“granddaughters”), as a rule, are not speakers of their native language and bearers of the culture, and their ethnic identity is expressed in preserving the memory of their ancestors.

Implications for the institution of mixed agreements in European Union law arising from the evolving nature of in foro externo competence

Due to the growing political debate on the necessity to revise primary law in the European Union (hereinafter: Union, EU), whereby the division of competences between the Union and its Member States is to be altered, there is a growing urgency to take a closer look at the potential consequences of these changes in regard to the ability to establish international relations – both by the EU and by Member States. In practice, this ability is evident in particular in the specific legal institution of “mixed” agreements, the signatories of which (as a rule) are not only the EU and third states, but also Member States of the Union. This institution will continue to exist for as long as the issues of the division of competences, at the core of the consideration of the nature of mixed agreements in EU law, remain relevant. The capacity to shape international relations and pursue the objectives of the Union and the Member States is of considerable importance in the context of the current global challenges they face. Being able to act jointly in this field reduces potential tensions and conflicts of interest in the relationship between the EU and the Member States, thus strengthening the Union’s own subjectivity. This article seeks to find an answer as to whether, and if so to what extent, the changes in competences leading to the establishment of new EU exclusive competences might have the effect of limiting the institution of mixed agreements. It is also important to try to determine whether a possible restriction of the said legal institution could strengthen the EU’s position in international relations.

SGPocket: A New Graph Convolutional Neural Network for Ligand-protein Binding Site Prediction.

Drug research is a long process, taking more than 10 years and requiring considerable financial resources. Therefore, researchers and industrials aim to reduce time and cost. Thus, they use computational simulations like molecular docking to explore huge databases of compounds and extract the most promising ones for further tests. Structure-based molecular docking is a complex process mixing surface exploration and energy computation to find the minimal free energy of binding corresponding to the best interaction location. Our work is developed in the ligand-protein context, where ligands are small compounds like drugs. In most cases, no information is known about where on the protein surface the ligand will bind. Thus, the whole protein surface must be explored, which takes a huge amount of time. We have developed SGPocket (meaning Spherical Graph Pocket), a binding site prediction method. Our method allows us to reduce the explored protein surface using deep learning without any information about a ligand. SGPocket uses the spherical graph convolutional operator working on a spherical relative positioning of amino acids in the protein. Then, a final step of clustering extracts the binding sites. Tested and compared (with well-known binding site prediction methods) on a hand-made dataset, our method performed well and can reduce the docking computing time. Thus, SGPocket allows the reduction of the exploration surface in the molecular docking process by restricting the simulation only to the site(s) predicted to be interesting.

Teardrop Alignment Changes After Volar Locking Plate Fixation of Distal Radius Fractures With Volar Ulnar Fragments.

We assessed factors associated with change in radiographic teardrop angle following volar locking plate (VLP) fixation of volarly displaced intra-articular distal radius fractures with volar ulnar fragments (VUF) within the ICUC database. The primary outcome was change in radiographic alignment on follow-up imaging, defined as a change in teardrop angle from intra-operative fluoroscopy greater than 5°. Patients with distal radius fractures treated with a VLP within the ICUC database, an international collaborative and publicly available dataset, were identified. The primary outcome was volar rim loss of reduction on follow-up imaging, defined as a change in radiographic alignment from intra-operative fluoroscopy, teardrop angle less than 50°, or loss of normal radiocarpal alignment. Secondary outcomes were final range of motion (ROM) of the affected extremity. Radiographic Soong classification was used to grade plate position. Descriptive statistics were used to assess variables' distributions. A Random Forest supervised machine learning algorithm was used to classify variable importance for predicting the primary outcome. Traditional descriptive statistics were used to compare patient, fracture, and treatment characteristics with volar rim loss of reduction. Volar rim loss of reduction and final ROM in degrees and as compared with contralateral unaffected limb were also assessed. Fifty patients with volarly displaced, intra-articular distal radius fractures treated with a VLP were identified. Six patients were observed to have a volar rim loss of reduction, but none required reoperation. Volar ulnar fragment size, Soong grade 0, and postfixation axial plate position in relation to the sigmoid notch were significantly associated (P < .05) with volar rim loss of reduction. All cases of volar rim loss of reduction occurred when VUF was 10.8 mm or less. The size of the VUF was the most important variable for predicting volar rim loss of reduction followed by postfixation plate position in an axial position to the sigmoid notch and the number of volar fragments in the Random Forest machine learning algorithm. There were no significant differences in ROM between patients with volar ulnar escape and those without.

How boundaries work in higher education: an ethnographic account of Ph.D. students’ identity formation

ABSTRACT In this article, I argue that Ph.D. students’ construction of academic identity depends on the boundary-making process in academia. The presented ethnographic account of Ph.D. students at one of the research-intensive universities in Turkey is based on 15 months of fieldwork, including observations and 21 in-depth interviews with PhD students. This ethnographic study employs a two-headed approach: institution-based boundary-formation and Ph.D. students’ socialisation into academic habitus. The findings reveal that, first, the identity building process in doctoral education is constituted by the practices of institution-based boundaries, which enable Ph.D. students to accumulate symbolic and social capital; second, the practices of distinction through socialisation into academic life are developed, embodied, habituated, and integrated to academic identity and academic life as part of a habitus of doctoral education; third, identity formation is a social space of relational positions characterised by the supervisor-enforced social order, rooted in both authority and domination.

Tibiofemoral Subluxation on Radiograph as a Predictor of Location and Size of Osteochondritis Dissecans Lesions of the Knee.

Lower limb malalignment has been associated with osteochondritis dissecans (OCD). However, the location of the OCD lesion often is not concordant with the mechanical leg axis. Other potentially modifiable alignment parameters may influence the propensity for impingement of the femoral condyles. To assess differences in lower limb alignment (LLA) and relative tibiofemoral position between patients with medial (MFC-OCD) or lateral OCD (LFC-OCD) of the femoral condyle. Cohort study; Level of evidence, 3. Patients ≤30 years old who were diagnosed with unicondylar OCD between January 2010 and January 2020 were eligible for this study. Included were 55 patients (age, 20.8 ± 4.5 years)-46 with MFC-OCD and 9 with LFC-OCD. Preoperative standing long-leg radiographs were studied to obtain primary outcomes-including LLA and mechanical alignment analyses-and secondary outcomes-including knee joint obliquity angle; rotation angle; medial, central (c-subluxation), and lateral subluxation (L-subluxation) of the tibia relative to the femur in the coronal plane; and tibiofemoral joint line center distance (TFJCD). With regard to primary outcomes, LLA was significantly different between MFC-OCD (1.7°± 3.1° varus) and LFC-OCD (2.7 ± 3.1° valgus) (P < .001), and 78% (36/46) of patients with MFC-OCD had varus alignment, whereas 78% (7/9) of patients with LFC-OCD had valgus alignment (P < 0.002). With regard to secondary outcomes, patients with MFC-OCD had a more medial tibial position in relation to the femur, with a significantly smaller rotation angle (5.6°± 2.4° vs 9.6°± 3.6°; P < .001), a smaller C-subluxation (7.2 ± 6.6 vs 14.9 ± 8.8 mm; P < .01), a smaller L-subluxation (2.3 ± 2.6 vs 4.4 ± 2.7 mm; P < .05), and reduced TFJCD (3.5 ± 1.7 vs 6.6 ± 1.8 mm; P < .001) compared with the LFC-OCD group. For patients with MFC-OCD, the size of the OCD was significantly correlated with C-subluxation (r = 0.412; P = .006). LLA was significantly different according to OCD location. In patients with MFC-OCD, the tibia was subluxated medially, resulting in a change of joint geometry by approximation of the medial tibial eminence toward the medial femoral condyle, potentially causing excessive pressure overload and microtrauma of the cartilage. Interestingly, the extent of subluxation was correlated with OCD size.

Teachers’ Research Competence and Engagement: Basis for Research Development Plan

Teachers’ research and competence posited complementary synergy theorizing that teachers with higher research competence are engaged in research pursuits relevant to professional growth within the context of education. This research addressed six key objectives by profiling respondents, assessing teachers’ competence on framing questions and data collection, identifying literature and theoretical knowledge, and analyzing and presenting research data, and research engagement levels on motivation to write research, and difficulty in conducting research, determining significant relationships between competence and engagement, exploring the correlation between engagement and respondents’ profiles, and designing a research development plan. Employing an adapted survey questionnaire using a universal sampling method, 391 teachers across the two districts in the Division of El Salvador City were surveyed during the School Year 2023–2024. Statistical tools such as means, frequency, standard deviation, Pearson-r, and triangulations were applied for data analysis. Findings indicated a positive correlation between teachers’ research competence and engagement. A significant relationship was identified between engagement and moderating variables like related training and position. Despite the teachers being competent and engaged, their research work was hindered by the number of coordinatorships they handled. It is important to emphasize the research competence and engagement for educational improvement as it illuminates the current state of teachers’ research skills and lays the groundwork for a targeted Research Development Plan.

Building Climate Change into Medical Education: A Society of General Internal Medicine Position Statement.

Building expertise in climate and planetary health among healthcare professionals cannot come with greater urgency as the threats from climate change become increasingly apparent. Current and future healthcare professionals-particularly internists-will increasingly need to understand the interconnectedness of natural systems and human health to better serve their patients longitudinally. Despite this, few national medical societies and accreditation bodies espouse frameworks for climate change and planetary health-related education at the undergraduate (UME), graduate (GME), and continuing (CME) medical education level. As a community of medical educators with an enduring interest in climate change and planetary health, the Society of General Internal Medicine (SGIM) recognizes the need to explicitly define structured educational opportunities and core competencies in both UME and GME as well as pathways for faculty development. In this position statement, we build from the related SGIM Climate and Health position statement, and review and synthesize existing position statements made by US-based medical societies and accreditation bodies that focus on climate change and planetary health-related medical education, identify gaps using Bloom's Hierarchy, and provide recommendations on behalf of SGIM regarding the development of climate and planetary health curricula development. Identified gaps include (1) limited systematic approach to climate and planetary health medical education at all levels; (2) minimal emphasis on learner-driven approaches; (3) limited focus on physician and learner well-being; and (4) limited role for health equity and climate justice. Recommendations include a call to relevant accreditation bodies to explicitly include climate change and planetary health as a competency, extend the structural competency framework to climate change and planetary health to build climate justice, proactively include learners in curricular development and teaching, and ensure resources and support to design and implement climate and planetary health-focused education that includes well-being and resiliency.