Alpha-synuclein regulates the repair of genomic DNA double-strand breaks in a DNA-PKcs-dependent manner.

α-synuclein (αSyn) is a presynaptic and nuclear protein that aggregates in important neurodegenerative diseases such as Parkinson's Disease (PD), Parkinson's Disease Dementia (PDD) and Lewy Body Dementia (LBD). Our past work suggests that nuclear αSyn may regulate forms of DNA double-strand break (DSB) repair in HAP1 cells after DNA damage induction with the chemotherapeutic agent bleomycin1. Here, we report that genetic deletion of αSyn specifically impairs the non-homologous end-joining (NHEJ) pathway of DSB repair using an extrachromosomal plasmid-based repair assay in HAP1 cells. Importantly, induction of a single DSB at a precise genomic location using a CRISPR/Cas9 lentiviral approach also showed the importance of αSyn in regulating NHEJ in HAP1 cells and primary mouse cortical neuron cultures. This modulation of DSB repair is dependent on the activity of the DNA damage response signaling kinase DNA-PKcs, since the effect of αSyn loss-of-function is reversed by DNA-PKcs inhibition. Using in vivo multiphoton imaging in mouse cortex after induction of αSyn pathology, we find an increase in longitudinal cell survival of inclusion-bearing neurons after Polo-like kinase (PLK) inhibition, which is associated with an increase in the amount of aggregated αSyn within inclusions. Together, these findings suggest that αSyn plays an important physiologic role in regulating DSB repair in both a transformed cell line and in primary cortical neurons. Loss of this nuclear function may contribute to the neuronal genomic instability detected in PD, PDD and DLB and points to DNA-PKcs and PLK as potential therapeutic targets.

Physical Activity among Elderly Teachers Working in Basic Education Schools.

This study aimed to assess the levels of physical activity (PA) among elderly teachers. It was an epidemiological, cross-sectional, and analytical web survey conducted with teachers working in public basic education schools. Data collection took place between October and December 2021 through an online form. The dependent variable was physical activity practice, classifying teachers as either physically active or inactive. Descriptive, bivariate, and multiple analyses were performed using Poisson Regression with robust variance. A total of 1907 teachers participated in the study, of whom 5.6% were elderly, ranging in age from 60 to 72 years. Regarding PA practice, elderly teachers were found to be more physically inactive compared with adult teachers (PR = 1.18; 95% CI = 1.04; 1.34). Conclusion: A statistically significant difference in PA practice was observed between adult and elderly teachers, indicating that elderly teachers are more physically inactive.

Elevating Mentorship Competency for Sustained Impact via the University of Zambia Mentor Training Program.

The University of Zambia (UNZA) Mentor Training Program is conducted annually to strengthen the mentorship capacity of postgraduate programs for the health professions. This intensive five-session course trains faculty members in the mentorship of students. Established by senior UNZA leaders and US-based collaborators, this program was designed to address gaps in mentorship identified at the institutional level. Faculty facilitators developed the course curriculum and used a train-the-trainer model to ensure program sustainability. Participants were faculty members who mentor PhD and Master of Medicine students. To assess the program's impact, mentors and their mentees completed questionnaires on the mentor's mentoring competencies at the end of the course and 1 year later. Competency scores were compared longitudinally to quantify potential changes in mentoring behaviors. Mentors and mentees alike noted mentor growth in all competency domains from postcourse to 1 year later, providing evidence of a trend toward improvement in mentorship and that the program may have sustainable and positive effects on mentoring behaviors over time. Salient areas of growth corresponded to emphasized topics and discussions, including addressing diversity, aligning expectations, assessing capacities, motivating mentees, and fostering independence. These findings suggest that mentors internalized this content and transferred it to behavior change. The behavior changes may reveal a larger change in the institutional environment around the mentoring of students. The UNZA Mentor Training Program appears to have sustained impact after a year and should bode well for future benefits to students, faculty, and the institution.

Evaluation of Knowledge, Attitudes, and Practice in an Online Faculty Development Course for Anesthesia Educators in East Africa.

INTRODUCTION: Faculty in low-resourced communities often have limited training on teaching and learning. An innovative, online, 13-week course using a flipped classroom model was developed for junior faculty anesthesiologists at teaching hospitals in East Africa and piloted in Ethiopia and Tanzania. METHODS: Quantitative and qualitative data were collected and analyzed to evaluate potential change in participants' knowledge, skills, and attitudes as well as the feasibility of e-learning in the region. RESULTS: Analysis of data revealed that top areas of change in participants' knowledge were in the flipped classroom approach (increased by 79%), effective mentoring practices (67%), and elements of effective course goals and objectives (58%). Leading areas of change in skills were in developing goals and objectives (72%), using case-based learning (67%), and engaging learners through PowerPoint (64%). Change in attitudes was largest in the areas of effective mentoring and strong leadership (27%), using course and lecture learning objectives (26%), and student-centered learning theory (26%). Qualitative data revealed that participants were satisfied with the course; found the structure, presentations, and delivery methods to be effective; and appreciated the flexibility of being online but experienced challenges, particularly in connectivity. DISCUSSION: This evaluation demonstrated the efficacy of using e-learning in East Africa and highlights the innovation of online faculty development in a region where it has not been done before. By using participants as future instructors, this course is scalable in the region and worldwide, and it can help address limited access to training by providing a critical mass of trainers competent in teaching, mentoring, and leading.

Modelling admission lengths within psychiatric intensive care units.

OBJECTIVES: To examine whether discharge destination is a useful predictor variable for the length of admission within psychiatric intensive care units (PICUs). METHODS: A clinician-led process separated PICU admissions by discharge destination into three types and suggested other possible variables associated with length of stay. Subsequently, a retrospective study gathered proposed predictor variable data from a total of 368 admissions from four PICUs. Bayesian models were developed and analysed. RESULTS: Clinical patient-type grouping by discharge destination displayed better intraclass correlation (0.37) than any other predictor variable (next highest was the specific PICU to which a patient was admitted (0.0585)). Patients who were transferred to further secure care had the longest PICU admission length. The best model included both patient type (discharge destination) and unit as well as an interaction between those variables. DISCUSSION: Patient typing based on clinical pathways shows better predictive ability of admission length than clinical diagnosis or a specific tool that was developed to identify patient needs. Modelling admission lengths in a Bayesian fashion could be expanded and be useful within service planning and monitoring for groups of patients. CONCLUSION: Variables previously proposed to be associated with patient need did not predict PICU admission length. Of the proposed predictor variables, grouping patients by discharge destination contributed the most to length of stay in four different PICUs.

Accelerating Organizational Change to Build Mentorship Culture in Zambian Universities.

Strong cultures of mentorship and research remain underdeveloped at many African universities, threatening future knowledge generation essential for health and development on the continent. To address these challenges, a mentorship program was developed in 2018 at the University of Zambia with an aim to enhance the institutional culture of mentorship and to build institutional capacity through an innovative 'train the trainer' faculty development model. In this study, we documented perceptions of lived experiences related to mentorship culture by following trainers and trainees and their mentees over two years. We analyzed these perceptions to assess changes in institutional attributes regarding mentorship. We identified positive change in institutional culture towards mentorship, and this change appeared sustainable over time. However, a slight decrease in indicators for year two emphasizes the need for a continued culture of learning rather than assuming that one-off training will be sufficient to change culture.

Effectiveness of Intranasal Mometasone Furoate vs Saline for Sleep-Disordered Breathing in Children: A Randomized Clinical Trial.

Importance: Obstructive sleep-disordered breathing (SDB) in children is characterized by snoring and difficulty breathing during sleep. SDB affects at least 12% of otherwise healthy children and is associated with significant morbidity. Evidence from small clinical trials suggests that intranasal corticosteroids improve SDB as measured by polysomnography; however, the effect on symptoms and quality of life is unclear. Objective: To determine whether intranasal mometasone furoate is more effective than intranasal saline for improving symptoms and quality of life in children with SDB. Design, Setting, and Participants: The MIST trial was a multicenter, randomized, double-blind, placebo-controlled trial, recruiting participants from June 8, 2018, to February 13, 2020. Children aged 3 to 12 years who were referred to a specialist for significant SDB symptoms were included; exclusions were previous adenotonsillectomy, body mass index greater than the 97th percentile, and severe SDB. Randomization was stratified by site, and data were analyzed on an intention-to-treat basis from October 28, 2020, to September 25, 2022. Interventions: Participants were randomly assigned to receive mometasone furoate, 50 µg, or sodium chloride (saline), 0.9%, 1 spray per nostril daily, dispensed in identical bottles. Main Outcomes and Measures: The primary outcome was resolution of significant SDB symptoms (ie, reduction to a level no longer requiring referral to a specialist as per the American Academy of Pediatrics guidelines) at 6 weeks, measured by parental report of symptoms using the SDB Score. Results: A total of 276 participants (mean [SD] age, 6.1 [2.3] years; 146 male individuals [53%]) were recruited, 138 in each treatment arm. Resolution of significant SDB symptoms occurred in 56 of 127 participants (44%) in the mometasone group and 50 of 123 participants (41%) in the saline group (risk difference, 4%; 95% CI, -8% to 16%; P = .51) with 26 participants lost to follow-up and missing values managed by multiple imputation. The main adverse effects were epistaxis, affecting 12 of 124 participants (9.7%) in the mometasone group and 18 of 120 participants (15%) in the saline group, and nasal itch/irritation, affecting 12 of 124 participants (9.7%) in the mometasone group and 22 of 120 participants (18%) in the saline group. Conclusions and Relevance: Results of this randomized clinical trial suggest that there was no difference in treatment effect between intranasal mometasone and saline for the management of SDB symptoms. The results suggest that almost one-half of children with SDB could be initially managed in the primary care setting and may not require referral to specialist services, as is currently recommended. Trial Registration: Australian New Zealand Clinical Trials Registry: ANZCTRN12618000448246.

Sexual and reproductive health needs assessment and interventions in a female psychiatric intensive care unit.

AIMS AND METHOD: To assess the sexual and reproductive health (SRH) needs of women admitted to a psychiatric intensive care unit (PICU), and acceptability of delivering specialist SRH assessments and interventions in this setting. Within a quality improvement framework, staff were trained, a clinical protocol developed and clinical interventions made accessible. RESULTS: Thirty per cent of women were identified as having unmet SRH needs and proceeded to a specialist appointment, representing a 2.5-fold increase in unmet need detection. Forty-two per cent of women were assessed, representing a 3.5-fold increase in uptake. Twenty-one per cent of women initiated SRH interventions, of which 14% had all their SRH needs met. Staff, patients and carers highlighted the acceptability and importance of SRH care, if interventions were appropriately timed and patients' individual risk profiles were considered. Barriers to access included lack of routine enquiry, illness acuity and impact of the COVID-19 pandemic. CLINICAL IMPLICATIONS: SRH needs for PICU admissions are greater than previously realised. Providing a nurse-led SRH assessment is acceptable, feasible and beneficial for PICU patients.

The Relationship Between Perceptions of Physical Self-Worth, Subdomain Importance, and Physical Fitness in Adolescents With Low Motor Competence: An Exploratory Study.

Purpose: Adolescent perceptions of their physical self-worth (PSW) and the component domains draw upon physical attributes, such as motor competence, physical fitness, and self-perceptions, which in turn enhance the desire to engage in physical activity. Whilst these relationships have been researched in populations with typical motor development, little is known of the interplay of these contributors to PSW with those with low motor competence (LMC). Even less is known of how importance placed on particular physical subdomains may be used by the adolescent with LMC to mitigate negative effects on their perceptions of PSW. Method: Thirty-four adolescents with low motor competence, 25 boys and 9 girls (Mage = 13.89 yrs, SD = 1.49), completed the McCarron Assessment of Neuromuscular Development (MAND), the Children's Physical Self-Perception Questionnaire (C-PSPP) and a range of physical fitness tests. Results: All self-perception subdomain score was lower than importance ratings. Physical fitness measures were also low but were not significantly associated with PSW. However, the higher importance scores relative to physical self-perceptions resulted in greater discrepancy scores in all subdomains. Conclusion: Adolescents with LMC have low PSW, and low self-perceptions relative to importance ratings for most physical self-subdomains. These discrepancies, rather than actual fitness, potentially reduce their motivation to be physically active.

Self-report of worse back pain among teachers at state schools in Minas Gerais during the COVID-19 pandemic.

Introduction: One of the consequences of halting face-to-face educational activities during the COVID-19 pandemic was worse back pain. Objectives: To evaluate worse back pain in teachers working in elementary state schools in Montes Claros, MG. Methods: This is a websurvey-type epidemiological survey using an on-line questionnaire to assess sociodemographic characteristics, working conditions, health condition, and behaviors during the pandemic. Poisson regression was performed, with robust variance. Results: 15,641 teachers were included, and 35.4% reported worse back pain during the pandemic. It was found that the prevalence of a worse condition was higher among women (prevalence ratio = 1.15), between 40 and 49 years old (prevalence ratio = 1.14), teaching for more than 11 years (prevalence ratio = 1.11; 1.19), working more than 21 hours (PR = 1.05; 1.11), with difficulty to work remotely (prevalence ratio = 1.16), with poor quality of life (prevalence ratio = 1.30) or not (prevalence ratio = 0.84), obese (prevalence ratio = 1.07), sad or depressed (prevalence ratio = 1.21), anxious or nervous (prevalence ratio = 1.57), consuming alcoholic beverage (prevalence ratio = 1.16), with poor dietary habits (prevalence ratio = 1.07), more screen time (prevalence ratio = 1.24), sedentary lifestyle (prevalence ratio = 1.13), and social distancing (prevalence ratio = 1.08). Conclusions: The pandemic worsened back pain in teachers, demonstrating a need for addressing the issue, aiming at improving the quality of life of these professionals.

Introdução: Uma das consequências da suspensão das atividades presenciais educacionais durante a pandemia da covid-19 foi o aumento da dor nas costas. Objetivos: Avaliar o aumento da dor nas costas em professores, em atividade, na educação básica de escolas estaduais de Montes Claros, Minas Gerais. Métodos: Trata-se de inquérito epidemiológico do tipo websurvey, através de questionário on-line, para avaliação das características sociodemográficas, condições de trabalho, situação de saúde e comportamentos durante a pandemia. Foi realizada regressão de Poisson, com variância robusta. Resultados: Participaram 15.641 professores, sendo que 35,4% relataram piora da dor nas costas durante a pandemia. Houve prevalência da piora do quadro nos seguintes grupos: sexo feminino (razão de prevalência = 1,15), idade entre 40 e 49 anos (razão de prevalência = 1,14), acima de 11 anos na docência (razão de prevalência = 1,11; 1,19), jornada de trabalho superior a 21 horas (razão de prevalência = 1,05; 1,11), dificuldade no trabalho remoto (razão de prevalência = 1,16), qualidade de vida com piora (razão de prevalência = 1,30) ou não (razão de prevalência = 0,84), obesos (razão de prevalência = 1,07), tristes ou deprimidos (razão de prevalência = 1,21), ansiosos ou nervosos (razão de prevalência = 1,57), que consumiam bebidas alcóolicas (razão de prevalência = 1,16), com pior padrão alimentar (razão de prevalência = 1,07), tempo de tela aumentado (razão de prevalência = 1,24), ausência de atividades (razão de prevalência = 1,13) e adesão total ao distanciamento social (razão de prevalência = 1,08). Conclusões: O período pandêmico trouxe um agravo na dorsalgia em professores, o que demonstra uma necessidade de atenção à questão, visando uma melhoria na qualidade de vida desses profissionais.

Afastamento do trabalho por distúrbios musculoesqueléticos entre os professores da educação básica no Brasil / Work absence due to musculoskeletal disorders among basic education teachers in Brazil

Resumo Objetivo: investigar fatores associados ao afastamento do trabalho por distúrbios musculoesqueléticos entre professores e professoras da educação básica brasileira. Métodos: estudo transversal com amostra probabilística e representativa das grandes regiões do Brasil. Por meio de entrevistas realizadas por telefone, foi aplicado questionário para coleta de informações sociodemográficas, sobre estado de saúde, afastamentos do trabalho e características do trabalho docente. Empregou-se regressão de Poisson com variância robusta, para estimar razões de prevalência (RP) e intervalos de confiança de 95% (IC95%). Resultados: entre os 6.510 professores participantes (63,2% do sexo feminino), a prevalência de afastamento por distúrbios musculoesqueléticos foi de 14,7%, sendo 16,5% para o sexo feminino e 11,7% para o masculino. Os resultados indicaram associação entre afastamento e indisciplina em sala de aula (feminino = RP: 1,36; IC95%: 1,11;1,67; masculino = RP: 1,35; IC95%: 1,02;1,78), violência verbal praticada por estudantes (feminino = RP: 1,16; IC95%: 1,01;1,35; masculino = RP: 1,54; IC95%: 1,22;1,95) e alta exigência das tarefas profissionais (feminino = RP: 1,17; IC95%: 1,01;1,36; masculino = RP: 1,27; IC95%: 1,01;1,60). Conclusão: os fatores associados aos afastamentos do trabalho por distúrbios musculoesqueléticos estão relacionados à exposição dos professores, de ambos os sexos, à sobrecarga de trabalho e a ambientes escolares estressantes.

Abstract Objective: to investigate factors associated with work absence due to musculoskeletal disorders among teachers of Brazilian basic education. Methods: a cross-sectional study, which used a probabilistic and representative sample of the major regions of Brazil. Through telephone interviews, a questionnaire was applied to collect socio-demographic information on health status, work absences, and characteristics of teaching work. Poisson regression with robust variance was used to estimate prevalence ratios (PR) and 95% confidence intervals (95%CI). Results: among the 6,510 participating teachers (63.2% female), the prevalence of leave due to musculoskeletal disorders was 14.7% (16.5% among women and 11.7% among men). The results indicated an association between absence and indiscipline in the classroom (female = PR: 1.36; 95%CI: 1.11;1.67; male = PR: 1.35; 95%CI: 1.02;1.78 ), verbal violence committed by students (female = PR: 1.16; 95%CI: 1.01;1.35; male = PR: 1.54; 95%CI: 1.22;1.95) and high professional tasks demands (female = PR: 1.17; 95%CI: 1.01;1.36; male = PR: 1.27; 95%CI: 1.01;1.60). Conclusion: the factors associated with work absences due to musculoskeletal disorders are related to teachers' exposure to work overload and stressful school environments.

Fatores associados a multimorbidades autorreferidas em trabalhadores da rede de saúde municipal / Factors associated with self-reported multimorbidities in workers from the municipal health network

Resumo Objetivo: estimar a prevalência de doenças crônicas não transmissíveis (DCNT) e investigar fatores associados a multimorbidades crônicas entre trabalhadores da rede de saúde municipal. Métodos: estudo transversal com profissionais da atenção básica à saúde de Diamantina, Minas Gerais, Brasil. Os dados foram coletados por entrevista com aplicação de instrumentos validados. Houve identificação das características individuais, hábitos e estilo de vida, estado de saúde e condições de trabalho da população estudada. Utilizou-se regressão logística para construção de modelos multivariáveis. Resultados: participaram da pesquisa 203 dos 257 trabalhadores elegíveis, 144 do sexo feminino e 59 do masculino. As morbidades mais prevalentes foram: sobrepeso (27,0%), hipertensão (17,2%) e depressão/estresse (16,2%). A presença de multimorbidades (28,6%) foi significativamente associada à idade superior a 48 anos (Odds ratio - OR: 4,28; intervalo de confiança de 95% - IC95%: 1,66;11,04), à presença de transtornos mentais comuns (OR: 3,23; IC95%: 1,50;6,96), enquanto o apoio social adequado no trabalho permaneceu como fator de proteção (OR: 0,25; IC95%: 0,11;0,57). Conclusão: a presença de multimorbidades foi associada a maior idade, presença de transtornos mentais comuns e características organizacionais do trabalho.

Abstract Objective: to estimate the prevalence of non-communicable chronic diseases (NCD) and investigate factors associated with chronic multimorbidities among workers from the municipal health network. Methods: cross-sectional study involving basic health care professionals from Diamantina, Minas Gerais, Brazil. The data were collected by an interview applying validated instruments. The studied population's individual characteristics, habits and lifestyle, health and work conditions were identified. Logistics regression was used to build the multivariate models. Results: 203 of the 257 eligible workers participated in this research, 144 women and 59 men. The most prevalent morbidities were: overweight (27.0%), hypertension (17.2%) and depression/stress (16.2%). The presence of multimorbidities (28.6%) was significantly associated to age over 48 years old (odds ratio - OR: 4,28; confidence interval of 95% - 95%CI: 1.66;11.04), to the presence of common mental disorders (OR: 3.23; 95%CI: 1.50;6.96), whereas the adequate social support at work remained as a protection factor (OR: 0.25; 95%CI: 0.11;0.57). Conclusion: the presence of multimorbidities was associated with older age, presence of common mental disorders, and work organizational characteristics.

Dificuldades no ensino remoto emergencial da rede pública estadual de Minas Gerais no período pandêmico / Difficulties in emergency remote of the state public network of Minas Gerais in the pandemic period / Dificultades en la emergencia remota de la red pública es- tatal de Minas Gerais en el periodo pandémico

Este estudo objetivou-se analisar as dificuldades encontradas no ensino remoto emergencial (ERE) pelos professores da rede pública estadual de Minas Gerais durante o período pandêmico da COVID-19. Trata-se de estudo transversal com coleta realizada entre agosto e setembro de 2020, tipo websurvey. Utilizou-se a dificuldade encontrada com o ERE como variável dependente e as independentes foram características sociodemográficas e econômicas, perfil ocupacional, recursos/materiais e processos do trabalho docente. Participaram do estudo 15.641 professores. Observou-se prevalência de 90,6% de dificuldades no ERE. Os resultados, obtidos por meio da análise de Regressão de Poisson (α = 5%), apontaram associações entre o ERE e os professores do sexo feminino, a falta de recursos/materiais, o acesso limitado à internet e o processo de trabalho docente deficiente. Evidenciou-se um conjunto complexo de dificuldades que exige adequação de políticas públicas ao novo cenário educacional durante e pós- pandemia.

The objective was to analyse the difficulties encountered in emergency remote teaching (ERE) by teachers from the state public network of Minas Gerais during the COVID-19 pandemic period. This is a cross-sectional study with data collected be- tween August and September 2020, web survey type. The difficulty found with the ERE was used as a dependent variable, and the independent variables were sociodemographic and economic characteristics, occupational profile, resources/materials, and teaching work processes. 15,641 teachers participated in the study. There was a prevalence of 90.6% of difficulties in the ERE. The results, obtained through the Poisson Regression analysis (α=5%), indicated associations with the ERE of female teachers, the lack of re- sources/materials, limited access to the internet and the poor teaching work process. A complex set of difficulties was evidenced, which requires the adequacy of public policies to the new educational scenario during and after the pandemic.

El objetivo fue analizar las dificultades encontradas en la enseñanza remota de emergencia (ERE) por docentes de la red pública estatal de Minas Gerais durante el período pandémico del COVID-19. Se trata de un estudio transversal con datos entre agosto y septiembre de 2020, tipo encuesta web. Se utilizó como variable dependiente la dificultad encontrada con el ERE, y las variables independientes fueron características sociodemográficas y económicas, perfil ocupacional, recursos / materiales y procesos de trabajo docente. 15.641 profesores participaron en el estudio. Hubo una prevalencia del 90,6% de dificultades en el ERE. El análisis de regresión de Poisson (α = 5%) indicó asociaciones con el ERE de las maestras, falta de recursos / materiales, acceso limitado a Internet y un proceso de trabajo docente deficiente. Se evidenció un conjunto complejo de dificultades, que requiere la adecuación de las políticas públicas al nuevo escenario educativo durante y después de la pandemia.

Africa rising: Opportunities for advancing theory on people, institutions, and the nation state in international business.

Africa is rising, but IB scholars have largely failed to take notice. We argue that this is a missed opportunity. Not only is Africa a dynamic and distinctive region, but its rise presents a number of puzzles for international business (IB) research, with phenomena that seem to challenge fundamental assumptions underlying IB theories. In order to unravel these puzzles and better explain business dynamics on the continent, we contend that there is a need for IB theorizing to place greater emphasis on the role of people, to balance IB's traditional emphasis on institutions, location-specific assets, and other macro-level attributes. We explore how this conceptual shift presents new avenues for inquiry into issues that are of importance for IB but have received limited attention to date. Such issues include entrepreneurial human capital, social networks, institutional co-evolution, and the informal economy. As such, we argue that, while extant theories in IB inform explanations and predictions regarding business activity across the continent, Africa's diverse and distinctive characteristics offer the potential to serve as a context for testing and developing generalizable, cutting-edge IB theory. Supplementary Information: The online version contains supplementary material available at 10.1057/s41267-022-00581-z.

L'Afrique est en plein essor, mais les chercheurs en affaires internationales (International Business­IB) n'ont pas réussi à en tenir compte. Nous argumentons qu'il s'agit là d'une occasion manquée. Non seulement l'Afrique est une région dynamique et distincte, mais son essor présente un certain nombre d'énigmes pour la recherche en IB, avec des phénomènes susceptibles de remettre en question les postulats fondamentaux sous-tendant les théories de l'IB. Afin d'élucider ces énigmes et de mieux expliquer la dynamique des affaires sur le continent, nous soutenons qu'il est nécessaire que la conception théorique en IB mette davantage l'accent sur le rôle de l'homme, pour contrebalancer l'importance traditionnelle accordée par l'IB aux institutions, aux actifs spécifiques localisés et à d'autres attributs au niveau macro. Nous explorons comment cette mutation conceptuelle ouvre de nouvelles voies d'investigation sur des questions qui ont de l'importance pour l'IB, mais n'ont pourtant reçu qu'une attention limitée jusqu'à présent. Ces questions comportent le capital humain entrepreneurial, les réseaux sociaux, la co-évolution institutionnelle et l'économie informelle. À ce titre, nous argumentons que, si les théories existantes de l'IB permettent d'expliquer et de prédire les affaires des entreprises sur le continent, les caractéristiques diverses et distinctives de l'Afrique offrent la possibilité d'utiliser celles-ci en tant que contexte pour tester et développer une théorie de l'IB généralisable et avant-gardiste.

África está en ascenso, pero los académicos de negocios internacionales no se han dado por enterados. Nosotros sostenemos que se trata de una oportunidad perdida. África no sólo es una región dinámica y distintiva, sino que su auge presenta una serie de rompecabezas para la investigación de los negocios internacionales, con fenómenos que parecen desafiar los supuestos fundamentales en los que se basan las teorías de los negocios internacionales. Para desentrañar estos rompecabezas y explicar mejor la dinámica empresarial en el continente, sostenemos que es necesario que la teoría de los negocios internacionales haga más hincapié en el papel de las personas, para equilibrar el énfasis tradicional de los negocios internacionales en las instituciones, los activos específicos de la ubicación y otros atributos a nivel macro. Exploramos cómo este cambio conceptual presenta nuevas vías de investigación sobre cuestiones que son importantes para negocios internacionales pero que han recibido poca atención hasta la fecha. Entre estas cuestiones se encuentran el capital humano empresarial, las redes sociales, la coevolución institucional y la economía informal. En este sentido, sostenemos que, si bien las teorías existentes de negocios internacionales informan sobre las explicaciones y predicciones relativas a la actividad empresarial en todo el continente, las características diversas y distintivas de África ofrecen el potencial de servir como contexto para poner a prueba y desarrollar una teoría de negocios internacionales generalizable y de vanguardia.

A África está crescendo, mas estudiosos de IB majoritariamente não perceberam. Argumentamos que esta é uma oportunidade perdida. A África não é apenas uma região dinâmica e distinta, mas sua ascensão apresenta uma série de enigmas para a pesquisa em negócios internacionais (IB), com fenômenos que parecem desafiar pressupostos fundamentais subjacentes a teorias de IB. A fim de desvendar esses enigmas e explicar melhor a dinâmica dos negócios no continente, afirmamos que é necessário que a teorização em IB dedique maior ênfase no papel de pessoas para equilibrar a ênfase tradicional de IB em instituições, ativos de localização específica e outros atributos de nível macro. Exploramos como essa mudança conceitual apresenta novos caminhos para a investigação de questões relevantes para IB, mas que receberam atenção limitada até o momento. Tais questões incluem capital humano empreendedor, redes sociais, coevolução institucional e economia informal. De tal forma, argumentamos que, embora teorias existentes em IB forneçam explicações e previsões sobre a atividade empresarial em todo o continente, características diversas e distintas da África ofereçam o potencial para servir como um contexto para testar e desenvolver teorias generalizáveis e de ponta em IB.

COVID-19 Pandemic Impact on Academic Global Health Programs: Results of a Large International Survey.

Background: The COVID-19 pandemic caused significant disruptions in international communications and travel for academic global health programs (AGHPs) in both high-income countries (HICs) and low- and middle-income countries (LMICs). Given the importance of international travel and communication to AGHPs, the pandemic has likely had considerable impact on the education, research, and administrative components of these programs. To date, no substantive study has determined the impacts of the COVID-19 pandemic on AGHPs in HICs and LMICs. This study assessed the impacts and resultant adaptations of AGHPs to pandemic realities with the goal of sharing strategies and approaches. Methods: This study applied a mixed methods sequential explanatory design to survey AGHPs in HICs and LMICs about the impacts of the COVID-19 pandemic on three program domains: education, research, and administration. First, we surveyed a range of AGHP stakeholders to capture quantitative data on the pandemic's impact. Subsequently we conducted semi-structured interviews with select survey participants to gather qualitative data expanding on specific survey responses. Data from both phases were then compared and interpreted together to develop conclusions and suggest adaptive/innovative approaches for AGHPs. Results: AGHPs in both HICs and LMICs were significantly impacted by the pandemic in all three domains, though in different ways. While education initiatives managed to adapt by pivoting towards virtual learning, research programs were impacted more negatively by the disruptions in communication and international travel. The impact of the pandemic on scholarly output as well as on funding for education and research was quite variable, although LMIC programs were more negatively impacted. Administratively, AGHPs implemented a range of safety and risk mitigation strategies and showed a low risk tolerance for international travel. The pandemic posed many challenges but also revealed opportunities for AGHPs. Conclusions: The COVID-19 pandemic disrupted AGHPs in HICs and LMICs in expected and unexpected ways. Programs noted some unanticipated reductions in education program funding, negative impacts on research programs, and reduced scholarly output. Many programs reported well-coordinated adaptive responses to the pandemic including, for instance, virtual (in place of in-person) collaboration in research. The pandemic will likely have lasting impacts with regard to education, research collaborations, and administration of programs.

Etiology, Comorbidities, and Health Service Use in a Clinical Cohort of Children With Hearing Loss.

OBJECTIVE: To examine etiology, comorbidities, and health service use in a cohort of children with permanent hearing loss. Receiving an etiological diagnosis can inform reproductive planning, rehabilitation outcomes, predict additional disabilities, and direct intervention or management decisions. DESIGN: Retrospective audit of 518 deaf/hard-of-hearing children attending a tertiary pediatric outpatient clinic (2016-2019) using descriptive statistics. We used linear regression to investigate the relationship between degree of hearing loss, comorbidities, and health service use. RESULTS: Of the 518 children who attended the clinic, 481 (92.9%) proceeded with testing for etiology. Most children (399/518, 77.0%) were diagnosed with hearing loss by 3 mo of age. Of the children tested, the cause of hearing loss was confirmed in 234/481 (48.6%), suspected in 113/481 (23.5%), and unknown in 134/481 (27.9%); 17/341 (5.0%) had congenital cytomegalovirus (CMV), 17/320 (5.3%) had enlarged vestibular aqueducts, 67/213 (31.5%) of children with bilateral hearing loss had connexin mutation, and 25/72 (34.7%) of children with unilateral loss had hypoplastic/absent cochlear nerve on imaging. The odds of having a definitive/suspected diagnosis were twice as likely for indivduals with profound hearing loss than mild hearing loss (OR 2.1; 95% CI, 1.2-3.9; P = 0.02). The majority (348/518, 67.2%) of children had medical comorbidities, and most children attended otolaryngology (453/518, 87.5%), early intervention (358/518, 69.1%), and genetic (287/518, 55.4%) services. CONCLUSIONS: Children with hearing loss have diverse etiologies, most have comorbidities, and attend multiple services. Most families elected to proceed with diagnostic testing for etiology. Current guidelines and expanded access to genetic testing identified a confirmed/suspected etiological diagnosis in 72.1% of children tested. The number of comorbidities correlated with service use, regardless of hearing loss severity.

Prevalence of Housing Insecurity in Survivors of Traumatic Injury.

BACKGROUND: Almost 20% of the US population are housing insecure (HI) due to inadequate living conditions, imbalanced costs to income, nonsustainable shelter, or overcrowding. Housing insecure and physical trauma share similar risk factors, but their direct association is not well elucidated. The objective of our study was to determine the prevalence of HI in survivors of traumatic injury. METHODS: We conducted a prospective cohort study at an urban, level 1 trauma center. A survey on social determinants of health was administered to adult patients, and demographic, injury specifics, and clinical outcomes data were collected. HI was defined by affirmative answers to questions related to history of homelessness or concern about sustainable shelter. The cohort was stratified by HI; groups were compared using the Mann-Whitney U and Fisher exact tests, as appropriate. RESULTS: Of 116 study participants, four were excluded due to missing data. Of the 112, 42 (37.8%) reported HI and most were black (69%) males (73.8%). There were no demographic differences between groups. Conversely, HI patients had a higher rate of penetrating traumatic injury (34.1% vs 14.5%, P-value = .03) and were significantly less educated compared to secure participants (P-value = .03) [no degree (26.2% vs 10.3%), high school degrees (21.4% vs 41.2%)] with concomitant illicit drug use (63.4% vs 27.9%, P < .001), and history of addiction (52.4% vs 7.2%, P < .001). CONCLUSION: HI far exceeds national averages in our cohort. Although difficult to ascertain a cause-effect relationship, HI may be a modifiable risk factor for trauma that negatively influences outcomes.

Porcine Models of the Intestinal Microbiota: The Translational Key to Understanding How Gut Commensals Contribute to Gastrointestinal Disease.

In the United States, gastrointestinal disorders account for in excess of $130 billion in healthcare expenditures and 22 million hospitalizations annually. Many of these disorders, including necrotizing enterocolitis of infants, obesity, diarrhea, and inflammatory bowel disease, are associated with disturbances in the gastrointestinal microbial composition and metabolic activity. To further elucidate the pathogenesis of these disease syndromes as well as uncover novel therapies and preventative measures, gastrointestinal researchers should consider the pig as a powerful, translational model of the gastrointestinal microbiota. This is because pigs and humans share striking similarities in their intestinal microbiota as well as gastrointestinal anatomy and physiology. The introduction of gnotobiotic pigs, particularly human-microbial associated pigs, has already amplified our understanding of many gastrointestinal diseases that have detrimental effects on human health worldwide. Continued utilization of these models will undoubtedly inform translational advancements in future gastrointestinal research and potential therapeutics.

Oropharyngeal Shedding of Gammaherpesvirus DNA by Cats, and Natural Infection of Salivary Epithelium.

Felis catus gammaherpesvirus-1 (FcaGHV1), a novel candidate oncogenic virus, infects cats worldwide. Whether the oropharynx is a site of virus shedding and persistence, and whether oronasal carcinomas harbor FcaGHV1 nucleic acid were investigated. In a prospective molecular epidemiological study, FcaGHV1 DNA was detected by cPCR in oropharyngeal swabs from 26/155 (16.8%) of cats. Oropharyngeal shedding was less frequently detected in kittens ≤3 months of age (5/94, 5.3%) than in older animals; >3 months to ≤1 year: 8/26, 30.8%, (p = 0.001, OR 7.91, 95% CI (2.320, 26.979)); >1 year to ≤6 years: 10/20, 50%, (p < 0.001, OR 17.8 95% CI (5.065, 62.557)); >6 years: 3/15, 33% (p = 0.078). Provenance (shelter-owned/privately owned) was not associated with shedding. In situ hybridization (ISH) identified FcaGHV1-infected cells in salivary glandular epithelium but not in other oronasal tissues from two of three cats shedding viral DNA in the oropharynx. In a retrospective dataset of 11 oronasopharyngeal carcinomas, a single tumor tested positive for FcaGHV1 DNA by ISH, a papillary carcinoma, where scattered neoplastic cells showed discrete nuclear hybridization. These data support the oronasopharynx as a site of FcaGHV1 shedding, particularly after maternal antibodies are expected to decline. The salivary epithelium is identified as a potential site of FcaGHV1 persistence. No evidence supporting a role for FcaGHV1 in feline oronasal carcinomas was found in the examined tumours.

Strengthening research capacity through an intensive training program for biomedical investigators from low- and middle-income countries: the Vanderbilt Institute for Research Development and Ethics (VIRDE).

BACKGROUND: Capacity strengthening initiatives aimed at increasing research knowledge and skills of investigators in low- and middle-income countries (LMICs) have been implemented over the last several decades. With increased capacity, local investigators will have greater leadership in defining research priorities and impact policy change to help improve health outcomes. Evaluations of models of capacity strengthening programs are often limited to short-term impact. Noting the limitations of traditional output-based evaluations, we utilized a broader framework to evaluate the long-term impact of the Vanderbilt Institute in Research Development and Ethics (VIRDE), a decade-old intensive grant development practicum specifically tailored for investigators from LMICs. METHODS: To assess the impact of VIRDE on the research careers of alumni over the past 10 years, we surveyed alumni on research engagement, grant productivity, career trajectory, and knowledge gained in grant writing. Descriptive statistics, including means and total counts, and paired sample t-tests were used to analyze the data. RESULTS: Forty-six of 58 alumni completed the survey. All respondents returned to their home countries and are currently engaged in research. Post-VIRDE grant writing knowledge ratings were significantly greater than pre-VIRDE. The number of respondents submitting grants post-VIRDE was 2.6 times higher than before the program. Eighty-three percent of respondents submitted a total of 147 grants post-VIRDE, of which 45.6% were awarded. Respondents acknowledged VIRDE's positive impact on career growth and leadership, with 88% advancing in career stage. CONCLUSIONS: Gains in grant writing knowledge and grant productivity suggest that VIRDE scholars built skills and confidence in grant writing during the program. A substantial proportion of respondents have advanced in their careers and continue to work in academia in their country of origin. Results show a sustained impact on the research careers of VIRDE alumni. The broader framework for research capacity strengthening resulted in an expansive assessment of the VIRDE program and alumni, illuminating successful program elements and implications that can inform similar capacity strengthening programs.