Work Of Committee Research Articles

Weight-Based Dosing in Hemophilia a: A Randomized, Controlled, Open-Label, Crossover Trial to Measure Factor VIII Recovery Following Factor VIII Concentrate Dosing Based on Total Body Weight, Ideal Body Weight, and Lean Body Mass

Introduction: The increasing prevalence of obesity has not spared the hemophilia population with rates similar to those in the general population. Obesity alters the pharmacokinetic properties of many drugs making it difficult to determine the appropriate dose when administering medications based on total body weight (TBW). Alternative descriptors of body weight, such as lean body mass (LBM) and ideal body weight (IBW) are sometimes used in these situations. Under-or overdosing of clotting factor concentrates in hemophilia may have catastrophic consequences. It has been demonstrated that when recombinant factor VIII (rFVIII) is dosed according to TBW in overweight and obese hemophiliacs, FVIII recovery values are greater than the expected 2.0 IU/dl per IU/kg. These findings suggest the need for alternative methods of rFVIII dosing in individuals whose morphometric characteristics differ from the ideal. Methods: We performed a single-center, randomized, controlled, open-label, crossover trial to determine if rFVIII dosing based on LBM and IBW achieves a targeted FVIII recovery with better precision than based on TBW in overweight and obese (body mass index ≥25 mg/m2), adult males (age ≥18) with hemophilia A (FVIII activity ≤0.40 IU/dl). Participants were randomized to 1 of 6 possible dosing sequence scenarios based on 3 different weight-based dosing regimens (TBW, LBM, and IBW). Recombinant FVIII dosing was calculated based on weight and a targeted FVIIII recovery of 2.0 IU/dl per IU/kg. Each subject administered his own rFVIII on three separate weeks following a washout period of at least 72 hrs. FVIII recovery was determined using the one-stage clotting assay obtained before and 30 min after infusion. Outcomes consisted of FVIII recovery and the proportion of participantsachieving a targeted FVIII recovery of 2.0 +/- 0.2 IU/dl per IU/kg 30 min after infusion. An intention-to-treat analysis was performed using mixed effects linear and logistic regression with random subject effect adjusted for week. Results: Between September 2015 and March 2019, 30 eligible patients were randomized to 1 of 6 rFVIII weight-based dosing scenarios consisting of TBW, LBM, and IBW. Nineteen participants completed the study. The mean age of participants was 34.6 +/- 11.3 years. The average body mass index (BMI) of participants was 29.2 +/- 3.5 kg/m2. Twenty-six participants had severe hemophilia A and 2 participants each had moderate and mild hemophilia A. Of those receiving at least 1 dose of rFVIII, Eloctate, 66.7%, Advate, 14.3%, and Novoeight, 9.5%, were the most commonly administered products. The mean FVIII recovery for TBW, LBM, and IBW-based dosing was 2.45 (95% CI: 2.27, 2.64), 2.08 (95% CI: 1.89, 2.26), and 2.17 (95% CI: 1.99, 2.35) IU/dl per IU/kg, respectively. The mean FVIII recovery was higher in TBW vs LBW and IBW-based dosing (Table 1).The proportion of participants with a targeted FVIII recovery of 2.0 +/- 0.2 IU/dl per IU/kg was 0.25 (95% CI; 0.09, 0.52), 0.39 (95% CI: 0.18, 0.64), and 0.54 (95% CI: 0.30, 0.77) for TBW, LBM, and IBW-based dosing, respectively. There was no difference in the proportion of participants with a targeted FVIII recovery of 2.0 +/- 0.2 IU/dl per IU/kg in TBW vs LBM and IBW-based dosing (Table 1). Discussion: In this study, rFVIII dosed according to TBW resulted in a higher FVIII recovery value than LBM and IBW-based dosing in overweight and obese, adult males with hemophilia A. There was no significant difference in the proportion of participants with a targeted FVIII recovery of 2.0 +/- 0.2 IU/dl per IU/kg in TBW vs LBM and IBW-based dosing; however, effect estimates favor alternative dosing strategies with LBM and IBW-based dosing 1.93 and 3.65 times, respectively, having greater odds of achieving targeted FVIII recovery. This may be due to limited statistical power as only 79.2% of the necessary number of participants completed the study. In addition, the rFVIII dose was erroneously calculated in 7 participants resulting in the administration of a smaller than intended amount. This primarily affected IBW and LBM-based dosing, which may have served to reduce the effect size above. In conclusion, based on these findings, overweight and obese patients with hemophilia A should undergo individualized pharmacokinetic studies using alternative descriptors of body weight to determine the most accurate, and cost-effective, method of achieving targeted FVIII recovery values. Disclosures Seaman: Takeda: Consultancy; Genentech: Consultancy; Spark Therapeutics: Consultancy; Bayer: Consultancy. Ragni:Alnylam Pharmaceuticals Inc., Baxalta/Takeda, BioMarin, Bioverativ, and Spark Therapeutics: Membership on an entity's Board of Directors or advisory committees; Sangamo: Consultancy, Research Funding; Takeda: Research Funding; Alnylam/Sanofi, ATHN, BioMarin, Bioverativ, Sangamo, Spark: Research Funding; Bioverativ: Consultancy, Research Funding; Spark: Consultancy, Research Funding; BioMarin: Consultancy, Research Funding; Alnylam/Sanofi, BioMarin, Bioverativ, Spark: Consultancy; American Thrombosis Hemostasis Network: Other: Committee work; Baxalta/Takeda, CSL Behring, Genentech, a member of the Roche Group, OPKO Biologics, and Vascular Medicine Institute: Research Funding.

Neutrophil Extracellular Traps Promote Joint Injury in Hemophilia

Hemophilic arthropathy (HA) is the predominant pathophysiology resulting from recurrent joint bleeding in individuals with hemophilia. HA leads to permanent joint damage, chronic pain and reduced quality of life. Despite major advances in the treatment to prevent joint bleeding, HA continues to be a major morbidity affecting hemophilia patients and the etiological mechanism contributing to the progression of HA remains elusive. Recent evidence suggests that joint-bleeding may promote the release of erythrocyte and tissue-derived damage-associated-molecular-pattern molecules (DAMPs) that can trigger the sterile inflammation in the joints, however, the innate immune pathways contributing to the development of HA remain unclear. Here, we used a model of knee joint injury-induced HA in FVIII-total knockout (F8TKO) mice and blood samples from hemophilia patients diagnosed with HA. In vivo multi-photon-excitation (MPE) fluorescence imaging of injured synovial cavity in live F8TKO or control mice was used to assess NETs formation within joint capsule. Imaging-flow-cytometry and ELISA assays were used to evaluate the number of circulating NETs in patients diagnosed with HA and mice with knee-injury. Scoring of the bleeding severity, histology, IHC and confocal imaging of joints were conducted to assess the joint injury in mice. F8TKO but not control mice manifested knee-joint injury and severity of bleeding 5-days post knee-injury. Progression of knee-joint injury was associated with increased neutrophil accumulation and NETs shedding within the synovium of F8TKO mice. Circulating NETs were significantly abundant in the plasma of hemophilia patients diagnosed with HA and F8TKO following knee-injury but not plasma of control humans or mice. These findings are the first to suggest that NETs contribute to pathogenesis of HA in hemophilia. Currently, experiments are underway to identify the innate immune pathways that promote NETs shedding, leading to joint-damage in hemophilia. Disclosures Ragni: Alnylam/Sanofi, ATHN, BioMarin, Bioverativ, Sangamo, Spark: Research Funding; Alnylam/Sanofi, BioMarin, Bioverativ, Spark: Consultancy; BioMarin: Consultancy, Research Funding; Bioverativ: Consultancy, Research Funding; Spark: Consultancy, Research Funding; Takeda: Research Funding; Sangamo: Consultancy, Research Funding; Alnylam Pharmaceuticals Inc., Baxalta/Takeda, BioMarin, Bioverativ, and Spark Therapeutics: Membership on an entity's Board of Directors or advisory committees; American Thrombosis Hemostasis Network: Other: Committee work; Baxalta/Takeda, CSL Behring, Genentech, a member of the Roche Group, OPKO Biologics, and Vascular Medicine Institute: Research Funding.

Draft Constitution of the “Thaw” period: historical-legal analysis

The author discloses details of the work of the Constitutional Commission on the new Constitution of the Soviet Union in the period from 1961 to 1964. The list of members of the Constitutional Commission, persons responsible for the formation of constitutional values at the initial stage of building a communist society, and their reassignment to subcommissions is published for the first time. On the example of the activity of the subcommission on the questions of “Public administration, activities of soviets, and nongovernmental organizations”, the author describes the organizational aspects of its work and the nuances of functionality. Assessment is given to the organizing role of apparatus of the Presidium of the Supreme Soviet of the USSR with regards to elaboration of a number of articles for the new Constitution, through the prism of the form and content. The article leans on the materials preserved in the State Archive of the Russian Federation (Fund 7523. Register 131). The presented material is the result of summary of archival research previously not available to the broad academic community. It allows you to debunk the myths that developed after publication of some works and memoirs on the topic. The article illustrates the contribution of staff members of the Presidium of the Supreme Soviet of the USSR and a researchers to the creation of the first constitutional framework of the establishing communist society. The author also lists the actors who made considerable contribution to the development of basic constitutional values.

Special Requests Analysis Committee: a key initiative in the context of health judicialization

To describe and analyze the work of a Special Commission, which technically evaluates litigations in a municipality in the regional area of São Paulo, in Brazil. Qualitative study, in which seven semi-structured interviews were carried out following the snowball technique. The discursive data was analyzed taking as reference some elements of the thematic analysis. The members of the Special Commission interviewed, answered questions related to four pre-established thematic axes: the work experience in the judicialization, the health-disease process, the responsibility of the health system regarding the user's well-being, and the right to health. In the first axis, they shared their work routine, exposed the tools they use to issue technical opinions, and recognized the relevance of the Commission to qualify the demands, rationalize public spending and approximate the areas of Health and Law. In the second axis, they highlighted the association between several constraints and determinants to be healthy or to develop a disease. In the third, they emphasized the relevance of integral care to promote well-being and reduce worsening. In the fourth, they affirmed that the right to health is not restricted to access to health care, but to the individual and collective elements that conform people, families and communities, and that the realization of the right to health is not a unilateral process. According to the empirical material, recognizing the different issues, perspectives, conditions and opinions related to the judicialization can help in its global comprehension and offer more just and rational possibilities for the realization of the right to health through the judicial process.

СТАНОВЛЕННЯ КОНКУРСНОГО ПРОЦЕСУ (ПРОЦЕДУРИ БАНКРУТСТВА) ТА ЙОГО РОЗВИТОК У 1990-х РОКАХ В НЕЗАЛЕЖНІЙ УКРАЇНІ

The article is devoted to the formation and development of the competitive process in independent Ukraine, namely in the 90s of the twentieth century, during its economic downturn. The normative legal acts of that period, which regulated the insolvency relations and the corresponding Explanations of the Supreme Arbitration Court of Ukraine, are studied. It is emphasized that the first act of the competitive process of independent Ukraine — the Bankruptcy Law at 1992, proved to be very simple to solve the problems of insolvency of large industrial enterprises. The author accentuates that this law in its essence resembled the competitive process of the XIX century, where there was only a liquidation procedure. The lack of a full-fledged financial recovery procedure, traditional measures of the bankruptcy process, a professional arbitration manager and legal deadlines for the regulation of bankruptcy proceedings led to litigation and unjustified liquidation of strategic industrial enterprises for the state. It is argued that the purpose of the Explanations of the Supreme Arbitration Court of Ukraine dated 18.11.1998 was to increase the efficiency of the law itself, mitigate the negative consequences of its application, resolve problems of simultaneous settlement of commercial disputes in litigation with consideration of monetary claims of creditors in bankruptcy proceedings. The important points of this Clarification are emphasized concerning the application of procedural norms, the legal status of the participants in the case, the structure and content of the application for initiating bankruptcy proceedings, the functions of the court, the work of the liquidation commission, etc. It is noted that the Clarification not only facilitated the work of arbitration courts and participants in the bankruptcy proceedings, but also allowed to properly understand the essence of the bankruptcy process itself, previously unknown to the legal science of Ukraine. It is argued that the Bankruptcy Law at 1999 was of revolutionary significance for the development of the bankruptcy process in Ukraine. He significantly intensified the activities of arbitration courts. Significantly increased the number of bankruptcy cases initiated by debtors, including large industrial enterprises. In many cases, the courts began to apply reorganization and amicable agreement procedures. There are differences between the Bankruptcy Laws at 1992 and 1999, in particular in their direction. As a result of the study, the author concludes that the benefits provided by the Bankruptcy Law of 1999 could be used by debtors in respect of whom cases were initiated under the "old" version of the Law. The activities of arbitration managers allowed to maximize the efficiency of the bankruptcy procedure in terms of financial recovery of debtors and repayment of creditors’ claims.

Decriminalize Drug-Checking Technologies in Pennsylvania to Prevent Overdose Deaths

Drug-checking technologies (DCTs), such as fentanyl test strips, prevent fatal overdoses caused by the adulteration of drugs. DCTs are currently classified as illegal drug paraphernalia in Pennsylvania (PA), but the recent and significant rise in fentanyl-related overdoses has prompted the PA House and Senate to propose exempting fentanyl test strips from the definition of drug paraphernalia. While fentanyl is currently the leading drug adulterant, other substances may be used to alter drugs. Therefore, we argue that broader reform is required to protect Pennsylvanians against all potential drug adulterants. We recommend that the PA House and Senate Judiciary Committees work to amend the PA Controlled Substance, Drug, Device, and Cosmetic Act to exempt all DCTs from the definition of drug paraphernalia. This proactive intervention will save countless lives by preventing adulterant-related overdoses.

Трансформація ролі дисциплінарної комісії у притягненні державних службовців категорій «Б» та «В» до дисциплінарної відповідальності у зв’язку із внесенням змін до деяких законів України щодо перезавантаження влади

The article analyzes the concepts of «official discipline», «disciplinary proceedings», «disciplinary case», «disciplinary responsibility» and establishes the connection among them. The paper also defines the powers and basic principles of work of the disciplinary commission. The authors clarify the procedure of formation of a disciplinary case and making decisions according to the results of its consideration.

House of Lords Committee Accommodation and Its Use: Restoration and Renewal in the 19th and 20th Centuries*

AbstractFollowing the 1834 fire, the work of house of lords committees continued virtually without interruption, at first in temporary accommodation and, from 1846, in rooms in the new palace designed by Charles Barry. This article charts the history of house of lords committee activity and the varied use of its accommodation at Westminster from 1834 to the present. Major committee work immediately following the fire included an inquiry into prison reform. Barry's accommodation was scantily fitted out, and quickly needed technical and other adaptations. Committees themselves changed too, with the heaviest phase of private bill activity needed for the creation of the railways tailing off by the late 1860s. Following a low point in committee activity between 1940 and 1970 committee work has developed in fits and starts from 1971 onwards. The further expansion of committees following the Jellicoe committee report of 1992 was accommodated by the reform of private bill procedure, which helped free up committee rooms, and in October 2009, the establishment of the Supreme Court meant that the law lords no longer sat judicially in the large committee rooms 1 and 2. Since 2012, however, the further expansion of committee activity has not been matched by an increase in its accommodation.

الأمم المتحدة ومشکلات الصراع على مناطق النفوذ مطلع الحرب الباردة المسألة الیونانیة أنموذجًا.

يعرض البحث للصراع الذي دار داخل الأمم المتحدة مطلع الحرب الباردة بين المعسکر الغربي بزعامة الولايات المتحدة الأمريکية والمعسکر الشرقي بزعامة الاتحاد السوفيتي حول اليونان، فيما سمي بـ وذلک من خلال محاور عدة تناولها أولا مجلس الأمن في محاولة للوصول إلى حل، وهي: اعتراض الاتحاد السوفيتي ودول الکتلة الشرقية التي تدور في فلکه على مسألة استمرار وجود القوات البريطانية في اليونان بعد انتهاء الحرب العالمية الثانية، وشکوى أوکرانيا ضد اليونان بسبب ما يقع من حوادث على حدود الأخيرة مع ألبانيا، وشکوى اليونان ضد جيرانها الشماليين (ألبانيا وبلغاريا ويوجسلافيا)، واعتراض دول الکتلة الشرقية على المعونة الأمريکية لليونان (مبدأ ترومان Truman)، والمجلس وتواصله مع لجنة التحقيق التي کان قد بعث بها إلى البلقان. وأمام عدم توصل مجلس الأمن إلى حل للمسألة في ظل وقوف الولايات المتحدة بما لها من أغلبية بداخله تؤيدها ضد أي طرح کانت لا تراه يتماشى مع مصالحها، واستخدام الاتحاد السوفيتي على الجانب الآخر لـ حق النقض لمنع تلک الأغلبية من استصدار أية قرارات کان يستشعر فيها عدم تحقيقها لرغباته أو تقييدها لتطلعاته، کان قرار المجلس في النهاية بإحالة المسألة إلى الجمعية العامة، ورفعها بالتالي من جدول أعماله. ويتناول البحث تفاصيل ما جرى بالجمعية العامة من جولة جديدة من الصراع بين المعسکرين الغربي والشرقي، والتي انتهت لصالح المعسکر الغربي، بقرار الجمعية العامة في 21 أکتوبر 1947 باعتماد تقرير لجنتها الأولى – اللجنة السياسية- التي کانت قد أحالت إليها المسألة لدراستها وتقديم تقرير عنها، لتتشکل بناء على ذلک اللجنة التي عرفت بلجنة الأمم المتحدة الخاصة بالبلقان بهدف مواصلة عمل لجنة التحقيق بشأن حوادث حدود اليونان ومحاولة إيجاد حل للمسألة. الکلمات المفتاحية: المسألة اليونانية، مجلس الأمن، الجمعية العامة، الولايات المتحدة الأمريکية، الاتحاد السوفيتي، حوادث الحدود، القوات البريطانية، السلام والأمن الدوليين، لجنة التحقيق. The United Nation and the crises of the struggle for spheres of influence at the beginning of the Cold War The question as a model Mustafa al-Gharib Muhammad. Assistant Professor of Modern and Contemporary History, Faculty of Arts, Benha University, Egypt. Email: mostafa.elkaser@fart.bu.edu.eg Abstract: The current study tackles the conflict that took place within the United Nations at the beginning of the Cold War between the Western bloc led by the United States of America and the Eastern bloc led by the Soviet Union about Greece, or what was called the Greek question. The research presents this conflict through dealing with several axes dealt with by the Security Council in an attempt to reach a solution. These axes are the objection of the Soviet Union and its satellite countries of the Eastern bloc to the continued presence of British forces in Greece after the end of World War II, Ukraine's complaint against Greece due to incidents occurring on the latter's borders with Albania, and Greece’s complaint against its northern neighbors (Albania, Bulgaria and Yugoslavia), the objection of the Eastern Bloc countries to US aid to Greece (the Truman Doctrine), and the Council and its communication with the investigation committee that it had sent to the Balkans. Also, as the Security Council failed to reach a solution to the issue in light of the United States’ opposition, with its majority in it supporting it, to any proposal against its interests, as well as the Soviet Union’s use of the veto right on the other side to prevent the majority from issuing any decisions against its interests, the decision of the Council was in the end to refer the issue to the General Assembly, and subsequently dismissed it. The research deals in details with the new round of conflict between the Western and Eastern blocs within the General Assembly. The conflict ended in favor of the Western bloc, as on October 21, 1947 the General Assembly approved the report of its first committee - the political committee - which the question had been referred to in order to study it and submit a report on it. Accordingly, the committee, known as the United Nations Special Committee on the Balkans, was formed to continue the work of the investigation committee on the incidents on the borders of Greece and try to find a solution to the issue. Keywords: The question, Security Council, General Assembly, United States of America, Soviet Union, Border accidents, British troops, International peace and security, Investigation Committee.

Теоретическое моделирование достижения консенсуса в условиях коалиций на основе регулярных марковских цепей

Теоретическое моделирование достижения консенсуса в условиях коалиций на основе регулярных марковских цепей

Діяльність Комісії прав людини Світового Конгресу Вільних Українців (1970-1980-ті роки)

На основі архівних документів та опублікованих спогадів проаналізовано діяльність Комісії прав людини Світового Конгресу Вільних Українців (СКВУ), спрямовану на привернення уваги до порушення прав людини в Українській РСР у 1970-х – 1980-х роках. З цією метою простежено причини утворення цієї структурної одиниці СКВУ, її склад і напрямки роботи. Встановлено, що основні зусилля Комісії прав людини були спрямовані на інформування світової громадськості про факти недотримання прав людини в УРСР шляхом публікації відповідних матеріалів, організації масових заходів (маніфестацій, прес-конференцій), скеровування звернень до міжнародних правозахисних організацій та державних діячів країн Заходу з проханнями встати на захист переслідуваних українських дисидентів.

Analysis of the Impact of Ship Draft Measurement Results on Shipowners' Decisions About Fleet's Operability

Abstract The article presents an assessment of the impact of the results of the measurement of the inland ship's draught on the shipowner's decisions regarding incurring financial expenses for maintaining vessels in operability by carrying out repairs and modernization The aim of the article is to present the possible actions taken by shipowners in response to the changing level of reliability of their vessels. The article assesses the impact of ship draught measurement results on shipowner’s decisions, with particular emphasis on operability. The analysis was carried out using data collected during the work of the Technical Inspection Commission in Szczecin in 2017-2018 regarding the draft and load capacity of ships.

МЕТОДИКА ЕКСПЕРТИЗИ РЕЗУЛЬТАТІВ ЕКСПЕРТНОГО ОЦІНЮВАННЯ

In modern conditions, namely, in the transformational processes of managing defense resources, aimed at developing the capabilities of the armed forces, making managerial decisions in the organizational systems of military and civilian control, the method of expert assessment is widely used.The expert assessment method is the basis for the work of commissions to check the state of military and industrial facilities, their level of readiness and security, including on the rational allocation of resources, the use of economic opportunities, mobilization training, and the like. The expert assessment also retains its relevance for the future during research exercises, checking the combat and mobilization readiness and security of the Armed Forces of Ukraine, facilities and sectors of the national economy and other state institutions that ensure the national security of the state and its components - military and economic security. Over the years of application, the mechanisms of expert assessment have been thoroughly worked out, requirements have been formed for the procedure for selecting experts, their level of competence, assessment procedures, the procedure for processing the assessment results and other activities. However, in expert assessment it is assumed that all experts are certainly qualified and objective. And if there are subjective errors in their conclusions, then they are levelled out by increasing the number of experts and repetitions of expert evaluation procedures.At the same time, under any circumstances and conditions of expert assessment, the role of the “human factor” remains, in other words, the possibility of bias, corruption in the actions and assessments of experts is not excluded. Especially such factors are possible in the course of managing large material and financial resources, in the case of a limited number of experts. And the consequences of these factors can lead to the irrational use of material values, significant damage, including in the process of developing the capabilities of the armed forces, combat and mobilization readiness.Thus, when applying expert assessment, especially in measures to manage the distribution of large material and financial resources, the problem of a reliable examination of the results of expert assessment is urgent. Such an examination, preferably, in addition to being reliable, should not be cumbersome, expensive, simple, and accessible for practical use.In this paper, on the basis of the analysis of “mechanisms of reasonable control” developed in the theory of active systems, a mechanism for checking (examination) of the results of expert assessment is proposed.

The politics of generating best practice knowledge: Epistemic practice and rendering space technical in a European Commission working group on education policy

This paper seeks to understand how best practice knowledge is constructed and maintained as a hegemonic form of policy knowledge. The paper argues that best practice is based on two claims: firstly, that best practice draws on situated practices of ‘what works’ in specific policy contexts, and secondly, that best practice uses these practices to build universal policy lessons that can be transferred across political space. How do policy actors tasked with generating best practices manage to deal with the challenge of integrating knowledge that is situated in particular places with knowledge that holds true across political space? The paper explores this question through the lens of political discourse analysis and studies the relationship between epistemic practice and the social construction of space. Drawing on observation and interview data, the paper analyses how best practices are generated by a group of education policy experts coordinated by the European Commission. Analysis demonstrates that producing best practices involves ‘rendering space technical’ whereby the complex, relational nature of political space is transformed into a series of ‘contextual variables’ from which universal policy mechanisms can be extracted. This allows for the enactment of an epistemic practice which draws clear distinctions between policy and political space rather than understanding them as co-constitutive – a dualism which is pivotal for upholding the hegemonic status of best practice. By analysing counter-hegemonic moments where the claims of best practice are called into question, the paper also considers alternatives to rendering space technical in policymaking practices.

What resources do clinical competency committees (CCCs) require to do their work? A pilot study comparing CCCs across specialties

Purpose Although a growing literature describes how clinical competency committees (CCCs) make decisions about trainees’ clinical performance, little is known about the resources these committees need to perform their work. In this pilot study, we examined key characteristics of CCC processes across generalist and surgical specialties. This study intended to clarify topic areas for further investigation. Methods A cross-sectional web-based survey of CCC chairpersons at two institutions was conducted in 2017. Survey items were designed to describe not only CCC work, including types of assessment data used and time spent discussing learners, but also resource needs such as faculty development, institutional support, and protected time for members. Results The response rate was 59% (16/27). Only 44% offered faculty development to members. There was strong support for the institution to assist with faculty development for CCC members (81.25%), workshops for program coordinators (87.5%) and optimizing residency management software to organize assessment data (81.25%). Most respondents did not receive protected time for their committee work (93.75%). Conclusions Further studies are needed to elucidate whether CCC work varies across specialties and the associated committee resource needs. There may be opportunities for institutions to assist CCCs with resources across specialties.

Redefining Coronavirus: Update on the Impacts of COVID-19 in the Rural Areas of Abia State

Public health professionals working in rural communities are aware of the health disparities which result from lack of physicians, limited services, and income during the pandemic. Also they are aware that some populations are more vulnerable than others. People in the rural areas are experiencing problems on their physical, social and economic life styles because the pandemic is exacerbating some inequities. Individuals especially women and children in the rural areas are facing barriers in accessing health care services due to lack of resources and availability of health care providers in the communities. With COVID-19, women are less likely to seek services, including sexual and reproductive health services. Such services may be postponed to limit exposure to COVID-19 infection. This is particularly disturbing because in addition to the women maintaining their own health, they are also responsible for taking care of the mental, emotional and physical health needs of their families as well as all domestic responsibilities. As such, women in rural settings face special challenges as a result of these significant roles they play. Therefore, the impacts of COVID-19 are exacerbated on women by virtue of their sex and the roles they play in the family. This is a qualitative study that reviewed the reports of the 36 health care professionals under the aegis of members of COVID-19 committee working in partnership with state government to control, prevent and cushion the effects of COVID-19 in the society. This study is therefore, a summary of the observations of the COVID-19 committee members made up of 10(27.8%) females and 26(72.2%) males. The study focused on exploring how individual lifestyles in the rural areas have been affected in the face of COVID- 19 pandemic by identifying the vulnerabilities in social, political and economic systems which can amplify the impacts of the pandemic. Findings showed that preventive measures like lockdown and social distancing rules, wearing of face mask, hand washing with soap, and environmental cleanliness were not observed. The study noted that health seeking behaviours, sexual and marital life including income, education, employment and social interactions were all negatively affected. Most hospitals were battered and health care professionals boycotted the hospitals for fear of being infected. It was found that lack of health workers in the hospitals caused a good number of individuals to engage in self-medications. Also most pregnant women delivered their babies at home and few with traditional birth attendants. Some of the women who had deliveries at home experienced complications during and after delivery. Unfortunately, the report showed that governments’ financial supports to these women and their family members were insignificant as the government was more concerned with mitigating the spread of COVID-19 than assisting women to have safe deliveries. Therefore, the vulnerable groups especially women, children, and the elderly who experienced threats to their safety and wellbeing as a result of the services that were disrupted during the pandemic, should be assisted so as not to lose their lives to preventable diseases.

The Academic Fellowship in Physician Assistant Education.

The rapid growth of the physician assistant (PA) profession has required PA programs to increase their efforts in the recruitment and retention of experienced faculty. One approach was the establishment of the academic fellowship concept in 1998. Since then, 5 PA programs have designed fellowships, 3 of which were implemented and graduated fellows. To institute and develop an academic fellowship takes time, resources, and buy-in from faculty and students. The structure of the curricula within the fellowships has been similar since 1998 and includes faculty development opportunities, lecture development and delivery, student assessment, small group facilitation, interprofessional education, and committee work. Most fellowship-trained educators have entered faculty positions after completion of their fellowship. They appear to use sound educational strategies in their teaching and are successful in their scholarly productivity. Academic fellowships are just one route in the transition to PA education, and while they may require a significant investment from the sponsoring institution and program, they can provide a unique opportunity for PAs to immerse themselves in the faculty experience before the full commitment to a career change.

The Courts, Intimate Partner Violence and Mental Illness: The Case of Dwight Lamon Jones

AbstractThrough the lens of the high‐profile spree killing perpetrated by Dwight Lamon Jones in 2018 in Phoenix, Arizona, this article examines the way the criminal and civil courts grappled with assessing the significance, extent, and outcome of the IPV and abuse directed at Dr. Connie Jones, Dwight Jones’s former wife. The case is unusual, not least because Dr. Jones had an upper middle‐class income and numerous resources IPV victims do not normally enjoy. Nevertheless, she felt the courts let her family down. Journalists, victim advocates, and others also criticized the Arizona courts. The article outlines the spree killing and the criticisms of the courts, narrates Jones over a period of nine years including the IPV and mental illness, and, through the work of the Study Committee convened by Arizona Chief Justice Bales, explores the potential use of IPV risk assessments in the courts, particularly the family court, and related matters. It concludes with recommendations regarding possible preventive interventions in IPV cases, including those addressing mental illness.

The National Board of Medical Examiners on Potential Conflicts of Interest.

To the Editor: As officers of the National Board of Medical Examiners (NBME), and as physicians, educators, and citizens, we are deeply concerned about the well-being of students and physicians, the quality of our medical education and training system, and the health of our patients and our society. We remain committed to excellence in assessment, maintaining the highest ethical principles and using the tools at the NBME’s disposal for the betterment of all. Carmody and Rajasekaran1 as well as Gesundheit2 raise serious allegations regarding financial incentives intermixed with speculation and anecdote. We correct information presented and expand on issues raised. The mission of the NBME is to “protect the health of the public through state of the art assessment.”3 Its 12-member governing board includes diverse individuals with experience in medical education, training, and health care, with one-third representing perspectives of patients. With the exception of the chair and treasurer, no board members receive honoraria, and the former donate these. The NBME strives to meet educators’ and students’ stated needs. Without exception, subject exams and self-assessments were developed in response to medical education needs. We feel they are well aligned with the NBME’s mission. Medical schools use these high-quality exams for evaluation and as common metrics for purposes, such as curriculum evaluation and accreditation self-study. The NBME also pursues its mission by advancing assessment through empiric research and through development of formative tools aimed at improving the clinical performance of health professionals. The United States Medical Licensing Examination (USMLE) program is jointly governed by the NBME and the Federation of State Medical Boards (FSMB). The NBME’s governing board does not and cannot unilaterally set USMLE fees, which are determined by individuals drawn from the NBME’s volunteer academic and professional health care community membership, balanced equally with representatives of the FSMB. USMLE fee increases have approximated the Consumer Price Index. USMLEs are the work of over 350 voluntary medical school faculty, state medical board members, and the public drawn from across North America. Examination content thus represents the judgments of dedicated experts not employed by the NBME or the FSMB. Pass/fail standard, or “cut-point,” decisions are based on surveys of thousands of stakeholders, including examinees, and on committee work undertaken by faculty and state board members. Thus, determination of the pass/fail standard relies on individuals without financial ties to the USMLE program. In 2019, the NBME began a review of its governance. Although we believe that any potential conflicts of interest are already well managed, we will carefully consider all concerns raised, and if needed, modify structures, policies, or procedures to ensure that any potential conflicts of interest are managed appropriately. The NBME remains committed to the highest standards of excellence in assessment, ethics, and service to the public and the health professions. Alfred F. Tallia, MD, MPHProfessor and chair of family medicine and community health, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, and chair, National Board of Medical Examiners, Philadelphia, Pennsylvania; [email protected]Paul M. Wallach, MDProfessor of medicine, Dolores and John Read Senior Professorship in Medical Education, executive associate dean for educational affairs and institutional improvement, Indiana University School of Medicine, Indianapolis, Indiana, and vice chair, National Board of Medical Examiners, Philadelphia, Pennsylvania.Latha Chandran, MD, MPHExecutive dean and founding chair, Department of Medical Education, Miller School of Medicine, University of Miami, Miami, Florida, and treasurer of the National Board of Medical Examiners, Philadelphia, Pennsylvania.

Методика оценки уровня конкурентоспособности современных педагогических работников

In modern economic (market) conditions, the factor of ensuring high competitiveness of teachers, as one of the most popular professions in society, is of particular importance. This explains the relevance of the study. However, scientific publications do not pay enough attention to the development of methods for assessing the level of competitiveness of teachers, and the available publications are usually descriptive. In the paper, the authors propose a methodology for assessing the level of competitiveness of teachers, based on a number of mathematical methods. The developed methodology can be used for quantitative assessment and self-assessment of teachers, as well as in the course of work of commissions for the certification of teachers in higher education system. It seems that the material will be useful for both beginners and experienced teachers, as well as all those who are connected with the issues of modern pedagogical science and practice.