ABSTRACT
Integrating goods movement into public/mass rapid transit (MRT) is an emerging initiative to improve urban freight transport services and sustainability. This paper explores new prospects to achieve extensive non-road city logistics based on a deep freight-on-rail-transit (FoRT) strategy. To begin, the strengths, weaknesses, opportunities, and threats (SWOT) of deep FoRT are analyzed in view of the development status quo of urban China. Next, a multi-criteria assessment model driven by real-world data and 11 quantified metrics is proposed to judge the suitability for developing the MRT-based integrated logistics system (MILS) in 16 Chinese cities. Finally, critical factors influencing MILS project adoption are explicated, and the possible supportive policies are discussed from aspects of planning, regulation, funding, marketization, and innovations. Results show that the alignment with national development goals, rich social-environmental benefits, and stakeholder interest are the primary drivers of deep FoRT strategy, whereas poor planning and decision-making, governance and management deficiencies, and high investment could be the main hurdles. Priority of MILS project adoption in the selected cities is divided into four tiers, where Shanghai, Beijing, and Shenzhen are recognized as the three best candidates. Strong and coordinated policies are needed to integrate the strategy into urban planning.
ABSTRACT
Learning Objectives: To survey EM clerkship directors (CDs) on their experience adapting an EM virtual rotation (VR) curriculum during the onset of the COVID-19 pandemic. Background: The recent outbreak of the coronavirus disease 2019 (COVID-19) altered the traditional paradigm of clinical medical education by necessitating distance learning, employing new educational platforms such as video conferencing and virtual simulation in order to reduce disease transmission, and to minimize the loss of student learning in lieu of reduced clinical exposure. While individual clerkships have shared their curricular adaptations via social and academic networking media, there is currently no organizational standard in establishing a non-clinical, EM virtual rotation (VR). Methods: A 21-item survey with quantitative and qualitative questions was disseminated between June and August 2020 to EM clerkship directors (CDs) via CDEM Listserv to describe their experience and perspectives in adopting a virtual EM rotation during the spring of 2020. Results: 59 out of 77 EM clerkship survey responses were analyzed. 52.5% adopted a VR while 47.5% did not. Of those who adopted a VR, 71% of CDs had 2 weeks or less with 84% reporting usual or increased clinical load while creating a new curriculum. Clerkships significantly diversified their asynchronous educational content and utilized several instructional models to substitute the loss of clinical experience. 71% of CDs did not feel comfortable writing a standardized letter of evaluation for students during the VR, with the majority citing inability to evaluate students' competencies in a clinical context. See Table 1 and Figure 1 for details. Conclusion: A crisis, such as COVID-19 necessitates change in all facets of medical education. While EM educators demonstrated the ability to create emergency remote learning with limited time, this was not equivalent to formal development of pre-planned virtual rotation experiences. Future faculty development and curriculum innovation are required to fully transition an in-person immersive experience to a noninferior virtual experience.
ABSTRACT
Intro/Background: Increased attention has been drawn to teaching medical students about health equity and social determinants of health (SDOH). Generally, these courses concentrate on large systemic issues without teaching students how to affect changes with individual patients or on the local level. Training students to apply SDOH at the individual patient level and to utilize existing community-based health equity initiatives will equip them to serve the complex health needs of future patients. Purpose/Objective: At our institution, third-year medical students have 1-week electives to explore areas of interest. This elective is designed to help students analyze problems their patients in the emergency department face from the framework of SDOH. Identified SDOH are used to create research and advocacy projects to promote policy change and improve health equity. The course emphasizes community and research-based advocacy and encourages students to develop both patient-focused and large-scale solutions. Methods: A 5-day course for third-year medical students combining didactic and clinical experiences with two students per course. We begin with a novel excerpt to analyze SDOH through a narrative. We then discuss the relationship between SDOH, research, advocacy, and health policy through looking at emergency medicine initiatives nationwide, COVID-19 initiatives, and local projects in our community. Students interview patients focusing on SDOH, research community-based initiatives and generate potential policy solutions. Outcomes (if available): Thus far three students have completed this elective. Students reported that they enjoyed hearing about other students' experiences, and stated that learning how to concentrate on these issues at a grassroots level was an enriching experience. Originally students were scheduled to spend 2 hours in the ED, but student feedback showed they desired more clinical time to appreciate the culture of EM and to focus initiatives appropriately. Summary: The emergency department has an important role in examining how the social needs of communities contribute to health outcomes. This course allows students to see the emergency department as an integral extension of the community, and an area to lead community and research-based health equity initiatives. By starting with a narrative piece, we introduce students to the concept of identifying SDOH that can affect individual patients, and later apply this through targeted clinical encounters. We focus on community resources that exist so we can apply solutions to the patient encounter in real-time, and identify small-scale, achievable projects that can help to increase our patients' overall health outcomes in the future. Although we focus on the effects of SDOH on personal health experience, we also discuss potential policy solutions and how to evaluate that policy in the emergency department, city, state, and national levels to increase health equity for all. We emphasize elevating the voices of those affected within the community to enact policy change and collaborate with the community for sustainable solutions. The strengths of this course design are the small class sizes that allow robust student participation, and in-person clinical experiences that improve learner comfort in addressing SDOH in future clinical encounters. Our initial student groups have expressed increased comfort identifying solutions through individual patient encounters and feel less discouraged when attempting to tackle the vast health disparities that exist in the United States' clinical landscape. This course is run by a single faculty facilitator which allows consistency and adaptability. Its limitation is dependence on one facilitator who has a nuanced understanding of the content to focus the student discussions appropriately. We are confident that this course allows students to embrace social emergency medicine and will develop more socially-minded physicians in the future.
ABSTRACT
Objective: To explore the CT imaging features of the 2019 novel coronavirus (2019-nCoV) infection in order to summarize the imaging characteristics of the disease and improve the ability of imaging diagnosis and early diagnosis of the disease. Methods: From January 13, 2020 to January 31, 2020, a total of 33 patients with 2019-nCoV infection diagnosed and treated by Suzhou Fifth People's Hospital were analyzed retrospectively, including 20 males and 13 females, with an average age of (50±12) years, ranging from 20 to 70 years old. There were 3 cases of mild type, 27 cases of common type and 3 cases of severe type.There were 2 cases with hypertension, 1 case with postoperative lung,1 case with diabetes, 1 case with chronic bronchitis, and 1 case with bronchiectasis.SPSS25.0 Chi-square test was used to analyze the distribution of lesions in each lung lobe; SPSS25.0 Spearman correlation coefficient was used to analyze the image score and clinical classification. Results: There were 3 cases (9.1%) with normal lung and 30 cases (90.9%) with Novel Coronavirus Pneumonia(COVID-19) of the 2019-nCoV infected patients. In the distribution of COVID-19, 29 cases (87.9%) were involved in bilateral lung and 1 case (3.0%) in unilateral lung. There was no statistically significant difference in the distribution of lesions in each lobe. The correlation coefficient between the degree of lesion distribution and clinical classification was 0.819, and the two were highly correlated.There were 30 cases (90.9%) with subpleural lesions, 17 cases (51.5%) with central lesions. There were many kinds of lesions, 25 cases (75.8%) had ground glass density shadow, 16 cases (48.5%) had consolidation, 12 cases (36.4%) had interstitial change, and 18 cases (54.5%) had interlobular septal thickening. Among the 22 cases, 10 cases had more lesions, 6 cases had no changes and 6 cases had less lesions. Conclusion: Most of the patients with 2019-nCoV infection have pulmonary inflammation.CT manifestations include multiple parts, subpleural area or middle and lateral field of lung, ground glass shadow and consolidation, or coexistence. Some cases have pleural thickening or interlobular septal thickening. CT images can indicate the diagnosis of COVID-19 and provide important basis for early detection and disease monitoring.