A Pandemic Instrument can Optimize the Regime Complex for AMR by Striking a Balance between Centralization and Decentralization.

Global antimicrobial resistance (AMR) is currently governed by a decentralized regime complex composed of multiple institutions with overlapping and sometimes conflicting principles, norms, rules, and procedures. Such a decentralized regime complex provides certain advantages and disadvantages when compared to a centralized regime. A pandemic instrument can optimize the regime complex for AMR by leveraging the strengths of both centralization and decentralization. Existing climate treaties under the UNFCCC offer lessons for achieving this hybrid approach.

The governance shock doctrine: Civic space in the pandemic

MotivationEmergencies heighten societies' need to be governed. Accordingly, the COVID‐19 pandemic put systems of public governance under severe pressure across the globe. Civic freedoms were widely curtailed for public health reasons. Scarce resources needed to be allocated swiftly, with little opportunity for debate.PurposeIn settings characterized by authoritarianism, violent conflict, and restricted civic space, relations between governments, civil society, and citizens at best tend to be fragile and fraught even in "normal” times. What happens when these settings are rocked by a profound shock such as the onset of a global pandemic?Methods and approachThis article is based on research on civic space and civic action shortly after the onset of the pandemic in three such settings—Mozambique, Nigeria, and Pakistan. Civil society advocates in each country tracked and interpreted events in real time, debated their responses, supplemented their own knowledge through key informant interviews, and compared experiences across countries.FindingsI argue that the three governments' responses to the COVID‐19 pandemic constitute a "governance shock doctrine,” based on the premise that shocks bring responses from the powerful that advance certain agendas. This patterned phenomenon, visible across the three countries, consists of "securitization” of the public health emergency, suppression of dissent, extension and centralization of executive powers, curtailment of press freedoms, and tightened regulation of civic space, including online space. Civic activism navigated or combated these attacks in various ways.Policy implicationsMeasures adopted in emergency situations tend to persist, threatening to lock civil society into living with pandemic‐era restrictions. Preventing this should be a global priority, and especially important where authoritarianism already looms. An energetic mobilization among national and international actors to reassert and protect civic space is needed if the erosion of civil liberties and normalization of autocratic governance wrought by the political‐military apparatus in so many countries during the COVID‐19 pandemic is not to become permanent, and if the inspired and progressive innovations in organic civic activism over the 2020–2021 crisis period are to survive and flourish.

Governing the pandemic: The politics of navigating a mega-crisis

This open access book offers unique insights into how governments and governing systems, particularly in advanced economies, have responded to the immense challenges of managing the coronavirus pandemic and the ensuing disease COVID-19. Written by three eminent scholars in the field of the politics and policy of crisis management, it offers a unique 'bird's eye' view of the immense logistical and political challenges of addressing a worst-case scenario that would prove the ultimate stress test for societies, governments, governing institutions and political leaders. It examines how governments and governing systems have (i) made sense of emerging transboundary threats that have spilled across health, economic, political and social systems (ii) mobilised systems of governance and often fearful and sceptical citizens (iii) crafted narratives amid high uncertainty about the virus and its impact and (iv) are working towards closure and a return to 'normal' when things can never quite be the same again. The book also offers the building blocks of pathways to future resilience. Succeeding and failing in all these realms is tied in with governance structures, experts, trust, leadership capabilities and political ideologies. The book appeals to anyone seeking to understand 'what's going on?', but particularly academics and students across multiple disciplines, journalists, public officials, politicians, non-governmental organisations and citizen groups. © The Editor(s) (if applicable) and The Author(s) 2021. All rights reserved.

The post-pandemic re-organization of birth centres and its impact on perinatal asphyxia in the province of Reggio Emilia

Objective. The pandemic forced the re-organization of birth hospitals in the province of Reggio Emilia. In 2018 there were four difference birth centres, in 2021 only two out of four were still working. The OBJECTIVE of the study was to evaluate if the centralization of birth centres had worsened the stillbirth rate and perinatal asphyxia (PA) outcome during the SARSCoV- 2 pandemic period (years 2020-21) compared to the pre-pandemic period (years 2018-19). Materials and Methods. Retrospective review of birth rate, recovery for PA rate and stillbirth rate in the province of Reggio Emilia. Results. Statistical data showed a decrease of overall births from 2018 to 2021 (7516 newborns in 2018-19 to 6363 in 2020- 21), in accordance with the national trend. The percentage of newborns in the NICU in Reggio Emilia increased from the pre-pandemic period (59.66%) to the pandemic period (83.66%). Regarding the stillbirth rate, we observed a decrease from the pre-pandemic period (3.20%) to the pandemic period (2.36%). As far as concerned the PA rate, the percentage showed a reduction from the pre-pandemic (0.44%) to the pandemic period (0.36%). We also observed a decrease of the hypoxic-ischemic encephalopathy (HIE) rate from 0.16% to 0.12%. Finally, three different outcomes were evaluated in patients admitted for perinatal asphyxia: mortality, brain imaging lesions and seizures. During the pandemic we observed a significant decrease in all of these (Table 1). Conclusions. Centralization of birth centres did not worsen perinatal diseases as far as concerns stillbirth, PA and HIE rate. On the contrary, we observed an enhancing of patients' outcomes.

The U.S.-Threat Discourse, Hawkish and Maneuvered Public, and China's Foreign Policy

It has been argued that Chinese public opinion is often instrumentalized by the government to accomplish maneuverability and flexibility in Chinese foreign policy. Meanwhile, the dynamic social media environment continues to develop in novel and sometimes unanticipated ways that have various consequences for Chinese foreign policy. Can the authoritarian Chinese government dynamically shape public opinion using social media as the main communication channel to produce and collect responses to international affairs? What effect does a highly unified public opinion have on China's foreign policy? The dynamics of posts on Weibo throughout 2020 and the frequency of comments pertaining to specific issues are examined in this study through content and sentiment analysis. The results demonstrate an alignment and suggest a correlation between Chinese public opinion and the attitudes of the party-state on China's foreign policy. The results indicate that Chinese public opinion exhibited an increasing sense of the superiority of China's achievements, an endogenous preference for more hawkish attitudes toward the U.S., and a drive for a "wolf warrior" diplomacy. This is both a consequence of governmental manipulation and education over the long term and a catalyst for a more hawkish foreign policy in the future. In the long run, the highly unified public opinion that has been intentionally created by the party-state may eventually require additional effort to justify foreign policy positions that the public considers insufficiently assertive.

The Public Investment Fund and Salman's state: the political drivers of sovereign wealth management in Saudi Arabia

Saudi Arabia's Public Investment Fund (PIF) has grown from marginal player to the most important economic actor in the Kingdom since 2015. Nevertheless, we know surprisingly little about the political economy of the PIF revamp. Against an unfavorable macroeconomic backdrop, I argue that shifts in PIF organization and orientation are fundamentally driven by the centralization of power within the circles of the Saudi ruling family since the rise of Mohammed bin Salman (MBS). The fund's governance framework and network of insiders forming the board of directors mirror the concentration of authority around MBS. In turn, PIF domestic activities shifted from scattered investment patterns associated with the competing influence of senior decision-makers to a highly authoritative and personalized strategy. Moreover, the PIF's response to COVID-19 further exemplifies the turn from a conservative strategy toward a short-term oriented approach to sovereign wealth management. Going beyond macro-level economic and institutional dynamics, the article introduces the role of political agency in SWF choices by stressing how political actors and the distribution of power within ruling elites shape SWFs. The article thus adds to the scholarship on domestic drivers of SWFs and contributes to debates surrounding the interplay between states and markets under processes of financialization.

Decentralized governance and collective action dilemma: Sub-national governments' responses to COVID-19 in China

While the Chinese government's responses to COVID-19 since its outbreak have been widely discussed, scant attention has been paid to the cross-regional variation in China in handling the pandemic in the early stage. This article adopts and synthesizes the theory of regionally decentralized governance and the institutional collective action dilemma framework to offer a novel analytical characterization of the pattern of sub-national governments' counter-COVID-19 initiatives in different policy areas and highlights the peer effect and regional competition dynamics. We provide three brief case studies to illustrate various institutional collective action dilemmas under this framework that emerged in pandemic responses and must be addressed through re-centralization. Despite its focus on China's regional responses to COVID-19, this paper prompts the construction of a broad analytical framework for precipitating a better understanding of the complex structure of China's political and governance system in a time of crisis.

Centralization and perceived control of COVID-19 during the pandemic: A cross-sectional study

Objective: To uncover the impact of centralization of COVID-19 and perceived control of COVID-19 on society during the pandemic. Method(s): We recruited a total of 1 041 people in this cross-sectional study. The data were collected using a questionnaire booklet covering demographics, a COVID-19-related information form, the Centrality of Event Scale, and the Perception of Control of COVID-19 Scale. We utilized independent samples t-Test, chi-square test, and one-way analysis of variance to analyze the data. Result(s): 1041 questionnaires were collected and no questionnaire were excluded from our study. Slightly more than half of the participants (51.2%) stated that social isolation impaired public mental health, while 30.1% reported adverse impacts of the pandemic on their sleep quality. Participants with changes to their sleep patterns were found to centralize COVID-19 more. Moreover, measures against COVID-19 and constant announcements of the daily number of cases in the media brought both positive and negative effects on people and further contributed to the participants' centralization of COVID-19. Individuals with low centralization scores were concluded to perceive COVID-19 as a minor disease. Healthcare professionals without a relative diagnosed with COVID-19 and those satisfied with treatment opportunities had a higher perceived control of COVID-19, while those who were not interested in statistical data on COVID-19 and who had difficulty complying with the rules had a lower perceived control of COVID-19. Besides, poorer perceived control of COVID-19 was found to adversely affect sleep quality. Furthermore, healthcare professionals scored higher on the inevitability subscale of the Perception of Control of COVID-19 Scale. Finally, among the participants, most COVID-19 survivors thought COVID-19 to be an avoidable disease. Conclusion(s): In addition to its physical impacts, COVID-19 adversely impacts on mental health, and these effects are closely linked to a society's centralization of COVID-19 and perceived control of COVID-19. Copyright ©2022 Journal of Acute Disease Produced by Wolters Kluwer-Medknow.

Effects of Process Changes on Emergency Department Crowding in a Changing World: An Interrupted Time-Series Analysis

Objectives: Crowding at the emergency department (ED) is a problem in many countries. Crowding research often fails to consider external influences. In this study, we aimed to evaluate the effects of various process changes on ED crowding while taking into account changing external circumstances, such as the Covid-19 pandemic and centralization of acute care. Method(s): During a six-year period, we assessed the effects of several interventions to improve patient flow, using an interrupted time-series approach. Main outcome measures were crowding measured with the National ED Overcrowding Score, length of stay (LOS) and number of exit blocks. We determined time points of the various interventions and external circumstances and built an interrupted time-series model per outcome measure. We analysed changes in level and trend before and after the selected time points using linear regression, with baseline slope variables included to control for secular trend. Result(s): Crowding decreased when medical staffing increased during peak hours, and when next-day appointments at the ED were shifted to the policlinics. However, the closure of a neighbouring ED and further expansion of beds at the remaining ED coincided with increased crowding. During the Covid-19 surge, LOS increased but we observed no changes in crowding and number of exit blocks. Some of the interventions showed paradoxical effects, such as increased crowding after installing a psychiatric team during peak hours, but decreased LOS and number of exit blocks. Conclusion(s): Our findings reflect the importance of progressive interventions in response to changing external circumstances, in the ongoing battle against ED crowding. Timely feedback on new interventions is vital to increase the success and sustainability of projects, and long-term effects corrected for changing circumstances are pivotal to decide which interventions to prioritize. Our results show that it is possible to improve ED processes, even during changing conditions in challenging times. Copyright © 2022

Local Development Policies in the V4 Countries - in the Light of the Impact of the Covid-19 Pandemic

The Visegrcid countries have similar administrative systems, therefore the major characteristics of their development policies are similar, but several differences can be observed. These similarities and differences are analysed by this paper. Poland has a regionalized system and a partially merged 1st tier municipal model. Therefore, local development has a significant role. Hungarian, Czech and Slovakian local development policies are limited by the fragmented spatial and municipal systems, however the Slovakian regions have a strong development characteristic. Centralization tendencies can be observed but their intensities are different. The Hungarian model is significantly impacted by the strong centralization of the last ten years. Similar structures evolved among the local development policies of the 1st tier municipalities: the detailed development policies can be observed among the larger, mainly urban municipalities, the local development policies of the smaller, rural municipalities are based on the personal cooperation and neighbourhood activities. The COVID-19 pandemic influenced the local development policies, their focus has been transformed partially, but the structure of the local policies did not change significantly, the differentiated structure remained untouched.

Self rule and covid 19 times: On how the pandemic unveiled rigidities and elasticities of the self government institutional framework

Initially the most common response to the Covid-19 crisis was the concentration of powers on executives and, in some compound systems, this concentration of powers also involved the centralization of powers on national/federal governments. Both the concentration of powers and its centralization have encroached the principle of self-government by dismantling it temporarily. The ease in which self-government was dismantled in some countries raises concerns on its solidness and on the actual capacity of some institutional systems to provide, by means of self-government, the accommodation and recognition of plurinationalism and diversity. In this chapter we examine the governmental reaction to the Covid-19 crisis in relation to self-government in five European plurinational countries: Switzerland, Belgium, the United Kingdom, Italy and Spain. © 2022 by Koninklijke Brill NV, Leiden, The Netherlands.

'WHO Action Framework to advance universal access to safe, effective and quality assured blood products: how far are we?'

In response to the recommendations of WHA63.12 (2010) resolution on availability, safety and quality of blood products, the World Health Organization has steadily implemented numerous initiatives over the years to assist countries in building and strengthening their national blood systems, although with uneven success. In February 2020, WHO has developed the WHO Action Framework to Advance Universal Access to Safe, Effective and Quality-Assured Blood Products 2020-2023, which proposes a renewed effort to scale up programme implementation and improve access to blood products. The Framework aims to provide strategic direction to global efforts to address barriers to safety and availability of blood products and focuses on six strategic objectives: (1) an appropriately structured, well-coordinated and sustainably resourced national blood system;(2) an appropriate national framework of regulatory controls;(3) functioning and efficiently managed blood services;(4) effective implementation of patient blood management to optimize clinical practice of transfusion;(5) effective surveillance, haemovigilance and pharmacovigilance;and (6) partnerships, collaboration and information exchange to achieve key priorities and jointly address challenges and emerging threats at global, regional and national levels. During 2020-2021, to achieve these strategic objectives, some activities have been conducted, in the form of development written guidance as well as country assistance. Guidance on Centralization of blood donation testing and processing, and guidance on Increasing supply of plasma-derived medicinal products (PDMPs) in LMICs through fractionation of domestic plasma;Education Module on Update clinical use of blood and Policy Brief on the urgent need to implement Patient Blood Management have been published and disseminated through webinars. To assist country in implementation of WHO guidance, webinars on strengthening blood system through effective blood regulation, online training on haemovigilance system and on self-assessment using the Global Benchmarking Tools plus Blood have already been conducted. Assistance has also been given to Egypt in developing a plan for plasma fractionation. Some challenges to implement the action framework at country level still exist, for example, weak government support and commitment to the blood program, limited resources, and the Covid-19 pandemic, which hinders holding face to face meetings which are still effective for some activities. Currently some guidance is under development, and the Achilles Project, which is a WHO project to assist country in improving quality of their plasma for fractionation, will be run in Senegal, in collaboration with the International Coalition led by ISBT. As soon as the Covid-19 pandemic situation allows for face-to-face meetings, country assistance in the form of training, country visit for assessment and twinning program will be increased, to accelerate implementation of the action framework at country level.

E-administration in Polish and Hungarian Municipalities – a Comparative Analysis of the Regulatory Issues

E-administration became on important issues of the development of the municipal administrations. In this paper we examined the regulation of poland and Hungary to examine the challenges of these reforms. The Polish and Hungarian municipalities have been strongly influenced by the digitalisation. In the fields of administrative decisions, decision-making and public service provision new tools and methods have been introduced. We should emphasise, that the centrally operated platforms can be even interpreted as a new, 'soft' tool of the centralisation. However, the Polish and Hungarian systems are similar, but there are differences which are related to the different competences and spatial structure of the municipal systems of the two countries.

Public procurement during the pandemic: experience of India and China

Purpose: The paper examines the public procurement experiences of India and China during the Covid-19 pandemic and locates them in a framework it proposes. The paper aims to enrich the knowledge of how public procurement could be strategically used in emergencies. Design/methodology/approach: For the two countries, the paper sieved through government orders and notifications promulgated during and for the pandemic, examined the prevailing laws and statutes that were invoked and comprehensively scanned online news portals to gather evidence. In addition, the author also engaged with select, relevant people in the sector who offered useful information about ground-level scenario. Findings: It is found that as compared to China, in India (a) despite the presence of significant flexibilities, (b) there was a little divergence from standard procurement practices, perhaps explained by (c) weaker governance capacity and legitimacy, (c) more allocative (rather than structural) goals of procurement and (d) higher levels of centralization. Research limitations/implications: The findings of this paper are based entirely on secondary evidence limited to health care as a category of spend. This paper looks at two large countries and not their internal variations in procurement quality. The framework can also be enriched further by drawing additional categories to make the theoretical framework more promising. Practical implications: The underlying design and motivation of public procurement policies in India need significant changes to make procurement policies responsive to disasters. Also, one can learn decentralization during emergency from the otherwise centralized politics in China. Originality/value: To the best of the author’s knowledge, this paper is the first attempt to compare pandemic procurement-related policies of the two large countries across the Himalayan border. It also attempts to develop a scale/framework on which emergency procurement in countries can be assessed. © 2020, Emerald Publishing Limited.

Decentralising Data Collection and Centralising Information in the People's Republic of China: Decentralise, Manage, and Service Reforms

Xi Jinping's ascent to power as Chairman of the Chinese Communist Patty (CCP) was accompanied by changes in national governance strategies in the People's Republic of China (PRC) that have progressively incorporated the use of big data. Shortly after, in May 2015, the Chinese State Council released a set of policy reforms under the abbreviation fang guan fu í&iřlM (decentralise, manage, and service). These reforms promoted big data led (1) market regulation, (2) supervision and management systems, and (3) service provision processes. By applying a case study analytical approach, this paper explores how advancements in big data contributed to these reforms aimed at centralising information in China. Combining the joint knowledge of surveillance and China studies scholarship, this paper offers evidence of big data surveillance streamlining China's fragmented intergovernmental policy system. We build on David Murakami Wood's 2017 outline of a political theory of surveillance and argue that decentralisation of data collection points and centralisation of both bureaucratic and public access to information are keycomponents of the Party-states regulatory governance strategy- incorporating the use of big data and comprehensive surveillance. Our findings have implications for future analyses of the relationship between political organisations and surveillance within other nation-state contexts, particularly in situations where Chinese technologies and systems are being adopted and adapted.

Optimization of Capacity Allocation Models with Effort Dependent Demand in Global Supply Chain

In a demand driven market, optimal allocation of capacity to the demand has been one of the major issues. In this paper, we consider a single global freight firm allocating its capacity to its own regional sales offices. The firm sells cargo space based on two types of contracts: long-term and spot sales. Regional sales offices utilize their effort to generate more demand in their designated region. In other words, it is assumed that the demand is dependent on their efforts. First, we find a closed-form solution for the optimal level of the efforts of a single sales office in a specific region. Then, we study the case when the firm allocates its limited total capacity to two sales offices. We investigate different methods of capacity allocation: decentralization, centralization, and mixed, by conducting numerical studies. Different from the traditional finding, we suggest that the decentralization method is not always dominated by the centralization method.

The Indian Banking System, Financial Fragility, and Deregulation

Indian banking has undergone structural changes from financial reform and the process of deregulation during the 1990s. Added to this is a new element, the COVID-19 pandemic, and its effects on the banking system. The categories of concentration and centralization of capital and the increasing instability of banking institutions will enable an assessment of banking fragility as well as the impact and repercussions of the pandemic. The economic fragility of India's banking system has been a constant over the past few decades. The objective of this article is to analyze the profitability of the banking system, the banks' non-performing loans and the government's strategy to prevent a banking crisis.

Half: A Prospective Multi-Centre Phase II Clinical Trial Evaluating the Efficacy and Safety of Tyrosine Kinase Inhibitors' Discontinuation after Two-Step Dose Reduction in Patients with Chronic Myeloid Leukemia in Deep Molecular Remission

Background. Treatment-free remission (TFR) has become a new treatment goal for chronic myeloid leukemia (CML) patients. However, usually abrupt tyrosine kinase inhibitors (TKIs) therapy discontinuation has been successful only in about half of eligible patients and it can cause burdening TKI withdrawal syndrome (TWS) in about 30% of them. Moreover, any robust clinical or biological factor predictive for successful TFR has not been identified yet. On top of that, sustainable deep molecular response (DMR) as the main prerequisite for TKI discontinuation attempt is achieved only in 20-40% of patients. The majority of CML patients, therefore, need to be treated with the effective and well-tolerated drug for a long time or even life-long. Study design and methods. With the recognition of all these aspects, we designed a nationwide prospective investigator-initiated phase II clinical trial HALF (ClinicalTrials.gov NCT04147533) in order to evaluate efficacy and safety of TKI discontinuation after previous two-step dose reduction in patients with CML in DMR (Fig. 1). Step-wise TKI dose reduction, i.e. half of the standard during the first 6 months after study entry, and the same dose given alternatively (every other day) during the next 6 months, was derived from pharmacokinetics and experimental data as well as from clinical trials' results. We assume that the step-wise and eventually meaningful TKI dose reduction enables a higher rate of patients achieving successful TFR with less pronounce TWS, or even would represent a more reasonable and safer alternative to the complete and sudden TKI interruption. This unique nationwide academic project has been facilitated by hematological patients care centralization in the Czech Republic. A primary study objective is to evaluate the proportion of patients in major molecular response (MMR) at 6 and 12 months and in TFR at 18, 24, and 36 months after the study enrollment, respectively, and molecular recurrence-free survival at all mentioned time points as well. Main secondary and exploratory objectives are: to evaluate the proportion of patients loosing MMR and in whom MMR and MR4.0 would be re-achieved after TKI re-introduction, time to MMR and MR4.0 re-achievement, FFS, PFS, OS, TWS, and QoL assessment, predictive factors for successful TFR identification, quantification of BCR-ABL1 using digital droplet PCR at both the DNA and mRNA levels, immunological profiling, BCR-ABL1 kinetics mathematical modeling, assessment of TKI pharmacokinetics, clonal hematopoiesis and pharmaco-economics. Results. The study was launched in December 2019;however, due to the COVID-19 outbreak, patients' recruitment started on June 16, 2020. Here, characteristics of the first 74 patients included in the study until April 2021 are presented. There were 37 males and 37 females, with median age at the time of diagnosis of 53 years (range, 23-74) and at the time of the study entry of 67 years (range, 35-86). A median time of CML disease, TKI treatment, and DMR duration before the study initiation was as follows: 9.9 years (range, 4.4-22.5), 9.8 years (range, 4.2-20.2), and 7.3 years (range, 3.2-18.3), respectively. The ELTS score was low, intermediate, high and unknown in 62.2%, 21.6%, 13.5%, and 2.7% of patients, respectively. At the time of study entry, 58 patients (79.5%) were treated with imatinib, 10 (13.7%) with nilotinib, and 5 (6.8%) with dasatinib, respectively, whereas in 63 patients (86.3%) it was in the first line of therapy. With almost half of patients (48.6%), the TKI dose was already reduced at the time of study entry. With 10 (13.5%) patients, interferon-α treatment preceded TKI administration. At the time of this preparation, on July 26, 2021, altogether 102 patients (from planned 150) have been enrolled in the study;48 of them (47.1%) have already moved to the second de-escalation phase and 9 (8.8%) patients to the TFR phase. There were 2 cases of confirmed MMR loss (both in month 8 after the study entry) and no patient experienced symptoms resembling TWS. Conclusions. Despite the COVID-19 pandemic, the HALF study was successfully launched and initiated in the majority of centers, with 102 already included patients and continuing intensive enrolment. Based on our very preliminary results, the step-wise dose reduction seems to be an effective and safe approach. More included patients, longer follow-up and further analyses are needed in order to reach all set up objectives. [Formula presented] Disclosures: Žácková: Angelini: Consultancy, Speakers Bureau;Novartis: Speakers Bureau. Faber: Angelini: Consultancy, Other: conference fees, Research Funding, Speakers Bureau;Bristol-Myers Squibb: Consultancy, Other: conference fees, Research Funding, Speakers Bureau;Novartis: Consultancy, Other: conference fees, Research Funding, Speakers Bureau;Pfizer: Other: conference fees;TERUMO: Other: conference fees. Bělohlávková: Novartis: Consultancy;BMS/Celgene: Consultancy. Horňák: Angelini: Honoraria. Svobodník: Roche: Speakers Bureau;Janssen-Cilag: Speakers Bureau. Machová Poláková: Incyte: Consultancy;Angelini: Consultancy;Novartis: Research Funding. Mayer: Principia: Research Funding.

How Cellular Agriculture Systems Can Promote Food Security

Cellular agriculture, the manufacturing of animal-sourced foods by cell cultures, may promote food security by providing a food source that is available, accessible, utilized, and stable. The extent to which cellular agriculture can promote food security, however, will depend in part on the supply system by which it produces food. Many cellular agriculture companies appear poised to follow a centralized supply system, in which production is concentrated within a small number of large plants and products are distributed over a wide area. This model benefits from economies of scale, but has several weaknesses to food security. By being built of a handful of plants with products distributed by a large transportation network, the centralized model is vulnerable to closures, as became clear for animal-sourced centralized system during the COVID-19 pandemic. Cellular agriculture systems are being built now;therefore, alternative supply system models of decentralized and distributed systems should be considered as the systems of cellular agriculture production are established. This paper defines both the requirements of food security and three possible supply system models that cellular agriculture could take and evaluates each model based on the requirements of food security.

North wales vascular surgery zoom webinar teaching programme for medical students and junior doctors

Aim: Surgical Education is now more widely delivered on virtual platforms due to the COVID-19 pandemic. Due to centralisation of Vascular Surgery services in North Wales to Glan Clwyd Hospital (Central), Medical Students, Junior Doctors and General Surgical Registrars have reduced exposure to the speciality and the management of common cases in neighbouring hospitals (East and West). Subsequently, we developed a regional virtual teaching programme to help bridge gaps in knowledge and to instil confidence when providing a service. Method: We developed a 4-part didactic webinar educational programme which covered parts of the medical undergraduate and MRCS curricula pertaining to Vascular Surgery. Under/Postgraduate educational leads from Central, East and West were contacted to promote our programme. Webinars were delivered on ZOOM video conferencing once weekly throughout December 2020. Feedback forms were collected on Google Forms™ and used 5-point Linkert scales to grade responses and analysis of data was carried out on Microsoft ExcelVR . Results: 186 feedback forms were collected and respondents reported significant improvements in knowledge in each of the subjects covered: [1] Abdominal Aortic Aneurysms - (2.59±1.07/5 to 4.23±0.65/5, p=<0.0001, n=60), [2] Acute Limb Ischaemia - (2.5561.11/5 to 4.21±0.72/5, p=<0.0001, n=42);[3] Chronic Limb Ischaemia (2.57±1.03/5 to 4.23±0.77/5, p=<0.0001, n=35);[4] Vascular Emergencies (2.94±1.28/5 to 4.37±0.63/5, p=<0.0001, n=49). Overall topic interest, presentational skills and clinical usefulness was also rated highly. Conclusions: Through this virtually delivered regional teaching programme, we successfully enhanced Vascular Surgery knowledge and addressed the educational needs of Medical Students and Junior Doctors across North Wales.