The characteristicsof this expansion are discussed, as well as the socio-political settingwhere such movement occurred, and the quality of education available basedon the data collected.this is a descriptive and cross-sectional study with a quali-quantitativeapproach, with the use of secondary databases.an accelerated and disordered growth of Nursing undergraduate courses wasidentified, as well as the number of vacancies, especially due to theparticipation of the private sector, especially since the year 2000.Geographical inequalities in the distribution of these courses and vacancieswere also identified.the strong expansion of higher education in Nursing, along with other healthprofessions, resulted in the strengthening of private higher educationinstitutions associated with economic groups, regional concentration, aswell as the excessive offer of distance learning without adequate evaluationof its quality or repercussions. The educational system responds both to thedemands of the health system and to the dynamics of the health labor market. In thissense, educational institutions are recognized as vital in the transformation of thehealth system and in economic and social development.stcentury. Its trends of expansion are especially related to the public policies,which influence, and even encourage, the increase of these institutions.The phenomenon of privatization in higher education in health has been characterizedas a marked dynamic and accelerated growth in education in the 21itutions.. Privatization also presents as a characteristic a strong appeal ofprivate HEI brands, competition, the exploitation of niche markets with sociallyprestigious professions, aggressive marketing, and profit-oriented pricingpolicies.In this study, the term “privatization” includes the expansion of private highereducation institutions which offer Nursing degree courses, directed by individualsor companies, and no longer by the State. In this process, there is a tendency toperceive the student as a consumer and education as a product. Privatpolicies.(-). In July 2019, the number of schools and actual vacancies were 1,348and 197,995, respectively.In Brazil, the first Nursing school appeared in 1890, in Rio de Janeiro and, in 1939,the first private Nursing institution was created in São Paulo. Until the end of the1950s there were only 33 Nursing courses in the country, of which 36% were of aprivate nature, in its immense majority confessional institutions-. In Julper inhabitant, on the other hand, it has producedinequalities in the distribution of institutions and questions on the quality ofeducation. Additionally, Nursing training in Brazil started to strongly contemplatethe Education at Distance (EaD) modality, with 82.000 vacancies offered by 9 HigherEducation Institutions (HEIs), all private.While the increase in the number of schools and vacancies can be considered positive,since it has increased access to higher education and improved the proportion ofprofessionals  private.. However, 80% of these professionals are located in countries with halfthe world’s population, a very unequal distribution especially in the poorest andlow- and mid-income countries. Despite this growth, until 2030 a shortage of 5.7million Nursing professionals is estimated, especially in countries with the highestburden of diseases.Nursing is the largest professional category in the health sector. Recent data fromthe World Health Organization (WHO) indicate a growth of 4.7 million professionalsin the period from 2013 to 2018, currently corresponding to approximately 59% of theworkforce in the sector worldwide. Recent WHO analyses indicate the need for growth in the mean number ofNursing graduates around 8% per year, but stress the importance that this expansionmust be linked to greater employability, strategies for the retention of theseprofessionals, development of competencies and skills associated with the needs ofhealth systems, and strengthening governance and leadership in Nursing.There is no evidence on how the increased number of vacancies and schools could solvethe problem related to the lack of health professionals. Recent.Currently, in Brazil there are 1,241 Nursing courses in the face-to-face modalityunder activity, that offer 193,217 vacancies, the immense majority being in privateHEIs, whose participation is of 87.8% in the offer of courses. The increase in theparticipation of the private sector, inherent to the global trends of the economicmodel, in the offer of services and in health education, also created opportunitiesin the measures that aimed at the expansion of the Universal Coverage of Health andthe flexibilization of laws and norms regarding the participation of private andinternational capital, besides reducing the inefficiency of regulatorystructures. In this sense, it is crucial to understand how universities operate inthe process of training human resources in market terms, since this reality does notalways appear in the public description of their function and often receives anegative connotation. Moreover, it is urgent to understand the factors affecting the size ofthe future health workforce to plan and propose more effective actions adjusted toeach reality.The understanding of workforce training is intrinsically linked to economicdevelopment and has important social, economic and political consequences. It isdifficult to assume that large economies reach advanced stages of developmentwithout high levels of innovation and quality in education, for example, which canbe considered basic components for placing a country at the forefront of the“information society”. In thinotation. Moreov reality.Thus, this article intends to describe, analyze and characterize the expansionmovement of Nursing undergraduate courses in Brazil, emphasizing the participationof the private sector, its role, impact and trends in Nursing training in thecountry., nurses, nursing assistants and technicians, obstetricians and midwivesare defined as Nursing professionals. Training takes between one and five years,varying according to the degree and the title. In this article, only the informationreferring to the professional qualified in higher level Nursing courses is analyzed,whose undergraduation varies from 4 to 5 years.In Brazil, in accordance with the Law No. 7,498/86, nursesIt is a study of the descriptive type, cross-sectional and with a quali-quantitativeapproach, whose analysis setting is Brazil. The quantitative data of this study werecollected in the period going from July 2019 to May 2020. The population of thisstudy is the higher education institutions with Nursing training courses, selectedwith the following criteria: i) higher education institutions with undergraduateNursing courses; ii) the administrative category of IES; iii) active course; and iv)teaching modality, if face-to-face or distance learning. All the institutions withundergraduate courses in activity were selected as Participants.The following variables of the study were selected: number of active Nursing courses,modality of the activity, if face-to-face or at distance, administrative category ofthe institution that offers the graduation course (if public or private), number ofauthorized vacancies, and the geographic location of the course or of theinstitution that offers it. As the variables were easily located, it was notnecessary to use any particular instrument for data collection.Data collection was carried out at the e-MEC websites, the Anísio Teixeira NationalResearch Institute (INEP) and the Workstation of the Observatory Network of HumanResources in Health of the Institute of Social Medicine of the State University ofRio de Janeiro (ObservaRH-IMS/UERJ). Regarding data treatment and analysis, wehighlight that, at the e-MEC website, we obtained the listed data referring to theperiod in force and effect, and that it was not possible to access data fromprevious years, which were obtained from the ObservaRH-IMS/UERJ database. Themicrodata from the 2017 and 2018 Higher Education Census were obtained from theAnísio Teixeira National Research Institute (INEP) website. The entire collectionwas conducted by a single researcher, with supervision and review by anotherresearcher. Subsequently, the data were compiled and organized into a table andgraphs, using Office Microsoft Excel resources.nursing education, nursing schools,private and privatization. Relevant articles published since the year2000, in English, Portuguese and Spanish, dealing with similar research studiesand/or the historical context of the development and expansion of Nursingundergraduate courses were considered. The search of the texts was made by aresearcher, with the participation of the other researchers in the analysis, in aqualitative manner, with emphasis on the content of the selected articles, in orderto complement the information of the research, as well as to compare them to otherstudies. Finally, regarding the ethical aspects, this study waives the approval ofany Ethics and Research Committee.The literature review was carried out in the PubMed, SciELO and Google Academicdatabases, in such a way to become aware of the existing production of the educationof nurses and of the expansion of private higher education in this area. For this,the following search terms were used: . By permeability we can understand the effects of the meeting oroverlapping of the State and the private sector in the various stages of productionand delivery of public policies. The effects can assume different outlines depending on the relationalpattern established at a given time, under certain historical, social, political andeconomic conditions.Changes in the education systems have expanded permeability to the privatesector. By perpolicies. The efnditions..The purchase and sale of services is no stranger to the state activity; however, thespeed and the characteristics of privatization in the last decades had much properaspects, especially in the educational sector. In this sense, there are no servicesexempted from the participation of the private sector; there are those where theprivate sector operates with less or very little expression.This section initially presents the profile of the privatization process in Brazil,highlighting some elements of the historical context and its characteristics. Thefollowing describes the growth trend of the private sector over the past few yearsand its geographical distribution across states and regions of the country..As far as Brazilian higher education is concerned and from a legal point of view,the State can and has transferred resources to private HEIs. In the case of thepublic policies that influence and even contribute to the expansion of privatehigher education institutions, there is a tendency to increase theexpressiveness of the private sector in the health sector globally.campi of existingfederal institutions, such as in the increase of the number of institutions orthrough restructuring programs, such as the Support Program for Restructuringand Expansion Plans of Federal Universities (Reuni); 2) expansion ofpost-graduation and knowledge entrepreneurship; 3) intense diversification ofcourses, institutions and teaching modalities, especially distance learning(EaD); and 4) expressive increase of private for-profit HEIs.The expansion of Brazilian higher education covers four categories: 1) expansionof vacancies, enrollments and courses in the federal HEIs by the Union, whichcan be observed both in the multiplication of fit HEIs.. Another interesting aspect is that, although political scenarioshave alternated between different political groups and parties with supposedlydifferent ideals of conformation, orientation and militancy, their leaders havemaintained a favorable direction for the expansion of private HEIs.From 1960 to 1970, a lucrative sub-sector of higher education businesses wascreated, when the establishments were still considered formally as non-profitinstitutions. AnotheLei de Diretrizes e Bases,LDB) is considered by most authors to be the basis of theprivatization process of higher education in Brazil. However, the participationof private for-profit HEIs, explicitly or not, already existed since the1960s.The 1996 Guidelines and Bases Law .Until the end of the 1940s there were 20 Nursing courses in the country, four inprivate HEIs. Since 1949, the Brazilian State stimulated the creation of newschools, by making the Nursing course compulsory in all the universities orheadquarters of medical schools. Law Noospitals. Only iAfter the 1968 University Reform, the Nursing degree finds again fertile groundfor expansion. If in the 1960s only three new courses were created, and the1970s saw the appearance of 39 new courses, 28 in public HEIs and 11 in privateinstitutions. From 1980 to 1990, 62 Nursing schools were created, 42 in publicinstitutions. The participation of private HEIs remained stable until the 1990s,when the enactment of LDB in 1996 promoted an alignment of the country’seducational policies with flexibilization, liberalization, diversification offinancing, and redefinition of the role of the State in education. So it is fromthe late 1990s that growth in the private sector surpassed that of the public inthe supply of courses and Nursing positions, as shown in .The public sector held more than half of the enrollment until 1998 but, in thefollowing year (1999), private course enrollment represented 54.5% of the totalin the country, continuing to grow over the years. Several factors contributedto the substantial expansion of Nursing courses and vacancies in the countryand, consequently, in the number of graduates: i) legal and normative documentsrelated to the allocation of Nursing professionals in services; ii) labor marketflexibility; iii) public policies that corroborated the expansion of the labormarket in the health sector; and iv) educational policies that make HEIs moretolerant and autonomous.Between 1991 and 2004, the number of available vacancies increased tenfold, from7,460 to 70,400, of which only 8% were in the public sector. The number ofactive courses in this period also increased expressively, going from 108 in1991 to 415 in 2004, with a total increase of 291,5%, confirming the leadingrole of the private sector with a growth of nearly 616%. The LDB contributedstrongly to this expansion, because in the period from 1991 to 1996, forexample, the growth percentage of higher education in Nursing was only 4.71%,while between 1996 and 2004 it was approximately 287%. The same trend wasnoticed in the following years. In 2003 there were 243 Nursing degree coursesoffered by the private sector and 89 by the public; in 2004, these numbers were322 and 93, respectively. The vacancies offered in 2003 totaled 41,937 in theprivate sector and 5,410 in the public sector; in the following year, thenumbers jumped to 64,803 and 5,597, respectively, an increase of 154.5% ofvacancies in the private sector. . The worst percentages of vacancies were recorded in the years2002, 2003 and 2004, with the equivalent of 18% in the private sector.However, although the number of vacancies for Nursing undergraduate students hasincreased considerably, the number of graduates has not followed the sameevolution; on average, the evasion percentage of Nursing vacancies ishistorically higher in private courses than in public courses and corresponds to38% in public institutions and to 62% in private ones. The woIn 2006, the first distance Nursing courses were created. In 2019, 130 courseswere offered by 9 institutions, distributed in 14 poles, totaling 82.000vacancies available in the EaD modality. Today, this modality represents 28% ofthe total vacancies offered for Nursing under-graduation in Brazil. In theprivate sector, compared to the face-to-face modality, distance learningrepresents 30,8% of the vacancies offered.The growth in the number of courses has not been uniform throughout the country’sregions, presenting inequalities between states and cities and concentrationsmainly in the capitals and metropolitan regions, where, in general, there is ahigher Gross Domestic Product (GDP) and, consequently, greater economic powerand greater concentration of income of the population, in addition to a previousinstalled capacity, both of human resources and of physical structure. Thelargest fraction of public investment has also occurred in these locations.The Southeast region, followed by the South, remained the epicenter for expandingcourses and vacancies. However, considering the proportion of expansion in theperiod from 1991 to 2004, it was the Midwest that had the most expressiveincrease, 480%, although in absolute figures the number of schools (n=29 in2004) was much lower than in the Southeast and South regions . Table 1 shows the current geographicdistribution of courses and vacancies in Brazil.Regarding the enrollments, in 2018, the private institutions received 91.5%, mostof them distributed throughout the Southeast region (37.8%), and followed by theNortheast region (31.1%). The Midwest and North regions had an index of justover 10%  and the South had a lower enrollmentrate (9.7%). The Southeast region stands out for having the highest enrollmentrates in recent years, as seen in Nine IES offer nursing courses in the modality EaD, with poles in almost all theBrazilian states. Two HEIs based in the state of São Paulo concentrate almost80% of all vacancies offered, as observed in Training in health is a vital component for the sustainability and effectivefunctioning of any health system. The responsibilities and roles of nurses asclinical professionals, leaders, policy makers, researchers, scientists andprofessors are fundamental to the effective and practical functioning ofeducation.. In Bahrain, Middle East, there is a strong incentive for students toenter the private sector, where they are offered a written guarantee of employmentin the private sphere, for when they graduate.The trend towards privatization of health education seems to have a global dimension.In China, with government encouragement, private institutions for the education ofhealth professionals developed rapidly, exceeding what public institutions were ableto offer, but with unbalanced geographical distribution and questions on technicaland educational capacity. In Bahgraduate.. Data from 2010 already signaled a large participation of the privatesector in Kenya, with 51% of 68 Nursing EAD courses(-). In India, in this same year, 88% of all the Nursing educationinstitutions were private, producing 95% of the total Nursing workforce. In 2017,the total of private institutions already reached 90.3%. In Saudi Arabia, in 2017,of the 39 HEIs, 13 (33%) are private.In Thailand in 2006, 19.6% of all the nurses trained in the country were graduatesfrom private institutions; in 2010, this percentage rose to 24.1%, confirming theimportance of the private sector in the training of these professionals. Data fwith 51% of 68 N courses-30. I private..The participation of the private sector in Nursing qualification around the world isvery expressive and raises questions, which in general orbit around four topics: i)the contribution of the private sector in the training of Nursing professionals; ii)concentration/distribution; iii) the trend to also be linked to the private sector;and iv) teaching quality.In Brazil, this expansion movement can be associated with two factors: a reduction infunding in the public sector and a flexibilization and relaxation of regulations,including the emergence and increase of distance learning courses, which brings todiscussion the component of quality of training., for example, and is also identified for medical schools. Similarly, in Brazil private hospitals are concentrated in cities withbetter economies and so are private medical schools, most of them located in theSoutheast (41.4%), especially in São Paulo and Minas Gerais, where most of theprivate hospitals are for-profit (57.8%). The concern with the imbalance in the geographical distribution alsooccurs in China, where 97 private HEIs are located in Western and Central China,economically more advantageous regions, while only 26 are in EasternChina.Despite the distribution/concentration of the Nursing schools in the country, it isclear that the argument that the expansion of the private sector would serve to fillthe gaps in the public sector corresponds to an opportunity for market expansion.This urban-centered pattern of distribution of private HEIs is also perceived inIndia, Kenya, South Africa and Thailand, for ex schools. Simila (57.8%). The cornChina.. Although the supply of nurses has grown, it coexists with low rates ofabsorption of these professionals by the public sector, often due to recruitmentinefficiencies or to poor working conditions. A similar setting has been describedin Kenya and India, where the imbalance between production (supply) and labor marketabsorption (demand) has strongly favored the migration of nurses in these countries. Recent analyses of the WHO projections estimate that the effectiveglobal demand for nurses would increase by nearly 33% between 2019 and 2039, yetmore than 220,000 professionals would not be absorbed either by the public sector,nor by the public sector.The disparities indicate how the interaction between the education system and thehealth system has been mediated by the Nursing labor market, taking into account thechallenges of governance and regulation. The results revealed imbalances andcritical mismatches in the demand and supply of nurses, especially in locationsoutside the major urban centers. In India, for example, only 9% of the Nursingschools are in locations with shortages of such professionals. Althouctively). Recentc sector.Although Brazil is not traditionally a “Nursing labor exporter” country, the growingtrend in the number of schools and the high supply of vacancies, coupled with theinability to employ these professionals, suggest a powerful space for migration. Inthe richest countries, the existence not only of a workforce mostly older and closeto retirement, but also of international recruitment companies that, besidessubsidizing the language course, offer good employment conditions and socialbenefits, has increased the interest in Nursing professionals from poor and low- andmid-income countries (PLMICs).. Another aspect is the reduction or freezing of the Nursing wages,increasing the number of worked hours and/or of multiple jobs in searching toguarantee personal/family income. In this context, the possibility of migrating abroad with theguarantee of a work contract can indicate a trend in the Nursing labor market. Inthe Philippines, for example, most private nursing schools have the participation ofinternational groups, especially British and European, which contribute financiallyto the opening and operation of these institutions, in addition to drawing up theguidelines and curriculum guidance for the training of these professionals, so thatthey are compatible and equivalent to the standards required in their countries,strongly encouraging the migration of this workforce.At the same time, contexts of economic recession, widely seen in these countries,affect all sectors of the economy, including health professionals. Being the largestprofessional group in the health sector, nurses are strongly affected by theattempts to balance the budget, whose simplest and quickest alternative foradjustment is the reduction in the supply of workers. Anothey income. In thi. Also in the field of teaching quality evaluation, it is worthhighlighting the existence of a gap in studies on the quality of the teaching staffin public and private educational institutions and the comparative percentage ofphysicians and masters, for example. It is known, however, that the vast majority ofprivate HEIs in Brazil do not direct the curriculum to research and, generally, theleading role in the scientific field of research is centered on the publicinstitutions.The exponential growth of the private sector alerts to the lack of qualifications ofthe teaching staff, which in general, in these institutions, presents higherturnover and less rigorous and more flexible criteria for the selection ofprofessors. Another important point is that the increase in the number of schoolsincreases the competitiveness of the most qualified university professors not onlyamong private HEIs, but also with public institutions. Also i requirements, in terms of aligning student admissions and trainingprograms with changes in the sociodemographic profile and population needs,maintaining health standards, establishing training schools in rural areas, andcollaborating with the public health system, as internship settings duringgraduation. However, more current studies are urgently needed.Internationally, some studies suggest that public institutions, in general, are in abetter position to respond to the countries’ FTS requireaduation,33. H. Although the regulation of higher education is monitored by theMinistry of Education, this institution lacks mechanisms and tools more adjusted tothe reality of the expressive quantity of HEIs and, in the specific case of Nursing,of the massive number of vacancies offered, especially in the at-distancemodality.The absence of an effective regulation mechanism by the State in Brazilian privatehigher education can be considered an incentive for expanding thissector,35. AThus, although the present study presents some limitations and difficulties, derivedfrom the use of different nomenclatures and modality of courses in the area and,despite the great amount of collected data, the analysis, paradoxically, is stillexploratory. Due to the inconsistencies and knowledge gaps on these processes, itsubstantially contributes to the scientific knowledge of Nursing research in thearea of management and evaluation of health education, whose production between theyears 2006 and 2015 was limited to 11%. At the same time, this study seeks tobroaden and enhance the discussion of the health workforce through the labor marketlens, proposing an analysis on the growth of the private education sector and itsimpact on the health systems.This study examines three major questions on Nursing schools: The first relates tothe strong expansion of higher education in Nursing alongside other healthprofessions, which has resulted in the strengthening of private higher educationinstitutions associated with economic groups and regional concentration. The secondrefers to the geographical distribution of the courses and vacancies, which isunequal in the country. And finally, the existence of the distance learningmodality. It is still a controversial method and very questioned in courses in thehealth care area, since the training does not do without personal interaction,especially for the end-object of the Nursing exercise, that is, care. Concerns onthe quality relative to the expressive increase in the number of courses andvacancies and the quality of Nursing training and of other health professions arefundamental for an effective planning of the health workforce.The growing number of schools and vacancies does not seem to be linked to articulatedstrategies to solve the problem of the growing demand for a sufficient and qualifiedhealth workforce. This situation is similar to that of many developing countriesthat have failed to establish an organic relationship between multi-professionaleducation and the health system. Innovative strategies to address this issue must bedeveloped to contribute to achieving universal health coverage and access.In the current context of the new coronavirus pandemic (COVID-19), distance learninghas become a priority in the HEI agenda, even without much information on itsdevelopment or its impact on the quality of training of the professionals and on thehealth labor market, except for the tendency to concentrate the educational offer ina few HEIs. This is a necessary and urgent research agenda in the context ofteaching health professions.The study sought to demonstrate the relevance and scope of the privatization processfor Nursing education, reflecting on the implications of this process in meeting thedemands of the health system in Brazil.Furthermore, it is expected to contribute to the development of a more practical andparticipatory research agenda involving different actors from the government,academic settings, civil society, private sector and associations, among others, aswell as to the process of evidence-based decision-making and political choices.


The SARS-CoV-2 pandemic in Brazil has grown rapidly since the first case was reported on 26 February 2020. As the pandemic has spread, the low availability of medical equipment has increased, especially mechanical ventilators. The Brazilian Unified Health System (SUS) claimed to have only 40,508 mechanical ventilators, which would be insufficient to support the Brazilian population at the pandemic peak. This lack of ventilators, especially in public hospitals, required quick, assertive, and effective actions to minimize the health crisis. This work provides an overview of the rapid deployment of a network for maintaining disused mechanical ventilators in public and private healthcare units in some regions of Brazil during the SARS-CoV-2 pandemic. Data referring to the processes of maintaining equipment, acquiring parts, and conducting national and international training were collected and analyzed. In total, 4047 ventilators were received by the maintenance sites, and 2516 ventilators were successfully repaired and returned to the healthcare units, which represents a success rate of 62.17%. The results show that the maintenance initiative directly impacted the availability and reliability of the equipment, allowing access to ventilators in the public and private health system and increasing the capacity of beds during the pandemic. In December 2019, an outbreak of viral infection was first reported in Wuhan, China, when several patients presented symptoms of pneumonia with unknown etiology ,4. In thBy the beginning of March 2021, a total of 120,002,856 cases of COVID-19 were confirmed worldwide, including 2,655,755 deaths, with confirmed numbers reaching 11,483,370 cases and 278,229 deaths in Brazil [Common symptoms of SARS-CoV-2 infection include respiratory symptoms, fever, cough, shortness of breath, and dyspnea. In cases where there is a moderate to severe clinical course, the infection can cause pneumonia, severe acute respiratory syndrome, renal failure, and even death ,11. PatiIt is already well established that respiratory failure is the most prevalent and feared complication of pneumonia caused by SARS-CoV-2, usually causing hypoxemia. In this case, 10 to 20% of cases become difficult to control, necessitating the use of frequent mechanical ventilation for weeks or months ,19. The The growing daily increase in the number of cases of COVID-19 and the need for intensive care have led to resource limitations in meeting the demand for mechanical ventilators for the treatment of severe acute respiratory syndrome worldwide. This has increased the search for new alternatives, including efficiently increasing production capacity ,20. TherSeveral countries, particularly those with fewer resources, had many difficulties in acquiring equipment, reflected in falling assistance and increased mortality, as was the case in Brazil ,25, wherThis context demanded fast, assertive, and effective actions to minimize the health crisis in Brazil, which quickly became the epicenter of the pandemic in Latin America ,31. ThusIn April 2020, estimates of Ministry of Health of Brazil indicated that the country would need about 20,000 additional ventilators, and at the peak of the pandemic, 2000 new ventilators would be needed per week . AccordiIn this work, we provide a brief overview of the rapid structuring of a collaborative network for the maintenance of mechanical ventilators during the SARS-CoV-2 pandemic. This network was named Initiative + Maintenance of Ventilators (I+M). In addition, we present the main results obtained and the social contribution of allowing access to this equipment in the public health system in Brazil, consequently increasing the bed capacity during the pandemic. This work has very important social relevance for Brazil in the context of the epidemic caused by COVID-19, which is still creating a high demand for respiratory care. Although the I+M represents a national network, this work presents specific results achieved by SENAI CIMATEC . This institution was the first and the main site of the I+M and was considered a reference for the entire Brazilian network, and therefore is the so-called Reference Unit in this work. A mechanical ventilator is considered an artificial external organ, originally designed to provide oxygenation and respiratory support for patients who cannot breathe enough on their own due to impaired lung system functions , a condiBased on the cycle between the inspiratory and expiratory phases of breathing, ventilators can are classified as follows: (i) volume cycled, where the ventilator cycles between inspiration and expiration once a preset tidal volume is achieved; (ii) pressure cycled, where the ventilator cycles between inspiration and expiration once a preset inspiratory pressure is reached; and (iii) time cycled, where the ventilator cycles between inspiration and expiration once a preset inspiratory and expiratory time has elapsed .Mechanical ventilators have the following elementary units : (i) InlA block diagram of a basic ventilator is shown in The reference unit received a total of 29 different ventilators models from 16 different manufacturers. These numbers show the complexity of the operation and of the standard procedures implemented in an emergency way to repair the ventilators.The voluntary network is composed of 39 maintenance sites distributed in 21 states of Brazil and is supported by the Ministry of Health, Ministry of Economy, Ministry of Defense, Brazilian Agency for Industrial Development (ABDI), and Brazilian Association of Clinical Engineering (ABEClin). The network was formed by 24 institutes of SENAI; 20 private companies , Globo Studios, Ford Motor Company, General Motors, Honda, Hyundai Motor Brazil, Votorantim Institute, Jaguar Land Rover, Mercedes-Benz Brazil, Moto Honda, Renault, Scania, Toyota, Troller, Usiminas, Vale, Volkswagen Brazil, and Volvo Brazil); 3 universities and technology institutions , University of São Paulo (USP-POLI), and Federal University of Espirito Santo (UFES)); and 1 federal foundation ).Located in the state of Bahia, the Reference Unit was the first maintenance site to start operation and led the implementation of the network through the design of protocols, establishment of procedures, and provision of training for all teams around the country. The aim was to transfer knowledge and accelerate the structuring of the network. In order to disseminate the methods and procedures, a series of national and international events were carried out through online platforms. The maintenance at the Reference Unit was performed mainly in two working spaces, as shown in The second workspace b was strIn addition to the equipment and infrastructure, it was also essential that the areas allowed for organization of the material and information (data) flow to ensure reliability and efficiency in the maintenance process. The guidelines also included flowcharts of the processes, an organization chart of the team, procedures for pickup and delivery operations, traceability tools for each ventilator during its stay at the maintenance site, external and internal logistics, purchasing process, and stock management and dashboards to facilitate communication with the team.In all areas, rules, guidelines, and materials related to health, safety, and environment (HSE) were also in place. The use of protective equipment, such as masks, face shields, coats, and gloves, as well as daily HSE meetings and scheduled reverse transcription polymerase chain reaction (RT-PCR) tests were mandatory.The administration and technical teams included employees of the maintenance site and volunteers, including specialists and technicians in medical and hospital equipment, clinical engineers, mechanical and electronic engineers, logistics engineers and analysts, project managers, safety technicians, purchase specialists, and communication and marketing analysts.Although results from the whole network are referred to in this section, this work focused on specific results achieved by the Reference Unit maintenance site located in Bahia state. The challenges faced and results achieved were quite similar for most maintenance network sites.The launch of the maintenance line was strategic planned by the Reference Unit based on the serious concern that most countries would experience a shortage of mechanical ventilators  and to p2, and its road network is 119,639 km long. In total, the Reference Unit received 536 ventilators for repair between 3 March and 25 September 2020 and supported 58 cities and 7 mesoregions in Bahia state.The first step was to establish a process and a team to map and get in contact with healthcare units that needed ventilator maintenance assistance, and plan the logistics to collect the equipment and generate a service order to control and ensure the correct return once the maintenance was completed. In the case of Bahia, according to the Bahia State Health Secretariat (SESAB), the service network involved in battling COVID-19 relied on 123 healthcare units. In terms of territorial extension, Bahia is the fifth largest state in Brazil, with 567,295 kmOnce the ventilator arrived at the maintenance site, a cleaning and disinfection protocol was initiated to allow the maintenance process to take place. The flowchart helped to standardize the protocols and procedures to be implemented around the country in order to ensure a safe and efficient maintenance process. All documents generated were distributed and used for training of all people involved. Here, a business continuity plan (BCP) was formulated to establish important rules and protocols following WHO guidelines , includiTechnical support was provided to every new maintenance site incorporated in the network. Training materials, operational ventilator manuals, and video classes were available to all members of the I+M. Different sorts of training were held; the initial training represented the beginning of the journey, so the dynamics necessary to carry out maintenance at the new sites could be understood, as well as the minimum infrastructure necessary to perform the project. There were 8 sessions that reached an audience of 100–160 people per session. The initiative sparked interest in other countries, thus it was adapted for Latin America, Africa, and WorldSkills member countries.Another sort of training was live broadcasts from specialists and clinical engineers to present specific ventilators and answer technical questions from the members of the network. The “Conversation with a Specialist” training sessions had a total live audience of 187 participants and all the videos were made available on YouTube, with more than 5900 viewers. The nationwide events were carried out using an online platform. The international trainings were broadcast via the Reference Unit’s official YouTube channel. All documents, procedures, and protocols generated were made available on a communication platform so that the technical teams at the maintenance sites could have access to implement the information in their processes during the I+M period. The open-source operation manuals are also available on the ANVISA website . DetailsThe training sessions proved to be a fundamental strategy to quickly empower the maintenance sites, contributing to increasing the number of ventilators successfully repaired. In total, 2516 ventilators were successfully repaired and returned to healthcare units, from 4047 ventilators received by the maintenance sites, which represents a success rate of 62.17%.The videos and technical live sessions discussing critical cleaning and disinfection protocols and procedures proved to be essential in creating a safer and heathier environment for all participants. In addition, the strategy to centralize all technical information in a hub allowed the network to have updated documents and technical information, crucial for the success and feasibility of the initiative.Besides all of the effort to rapidly launch the network, another challenge was to finance the new parts and components needed to replace damaged ones. Technological advances in the manufacture of mechanical ventilators with the incorporation of microprocessors and advanced features have led to significant improvements in this kind of equipment . Along wAs new members joined the I+M initiative, the project received more attention from additional companies/institutions for funding. As already mentioned, the last network report already counted 39 maintenance sites present in almost all states of Brazil, mobilizing in 53 institutions among SENAI units, companies, universities, foundations, and institutes. Additionally, another 18 companies and institutions, both private and government participants, supported the initiative with further funding. Their names have not been released for confidentiality reasons.The I+M initiative mobilized more than 800 people directly involved in the maintenance activities. Among these were mechanical, electronic, and clinical engineers, as well as technicians and specialists. The I+M initiative presented its final report on 15 December 2020. The numbers of mechanical ventilators received and repaired are presented in The Reference Unit maintenance site received a total of 536 ventilators from five states, 439 ventilators being sent only by the state of Bahia (279 recovered) , 41 fromIt is important to emphasize that this was an unprecedented initiative with regard to the maintenance of ventilators and no similar initiative, whether public or private, was carried out. Thus, without the support of this maintenance network, it is believed that it would not be possible to achieve this number of repaired ventilators.As already mentioned, the initiative received mechanical ventilators from public and private healthcare units. In the case of the Reference Unit, the majority of ventilators came from public healthcare units, as shown in The lead time to repair the ventilators, considering pickup, cleaning, disinfection, screening, spare parts acquisition, maintenance, tests, calibration, and returning to the healthcare units, was one of the biggest challenges for the maintenance sites. As presented in Although the Reference Unit produced a relevant number of repaired ventilators, as presented in In addition, due to contract rules, some manufacturers were only able to supply specific parts and components directly to the health units, which also affected the progress of the activities of the maintenance sites. For the 324 mechanical ventilators repaired by the Reference Unit, a total of 508 spare parts were used, resulting in an average of two items exchanged by equipment. The average expenditure per piece of equipment was USD 662.52.According to a report by CGU, a Brazilian public financial office that regulates the use of public resources, published in May 2020, states and cities spent an average of USD 16,000.00 for every new mechanical ventilator . DespiteSince the beginning of the pandemic, there have been concerns by health authorities that the amount of mechanical ventilators available for the treatment of COVID-19 was less than the demand for these devices, as the virus spread rapidly . The shoIn Brazil, ANVISA is responsible for the registration of ventilators, which considers, among other steps: viability and regularization of the company; control and project development; the conformity certification and the product registration. This is a bureaucratic and time-consuming process in normal times. Due to the pandemic scenarios, ANVISA has been adopting measures to flexibilize the ventilators registration, such as the technical note 356/2020, which simplifies and streamlines the medical equipment regularization processes .Another aspect that influenced the complexity of maintenance was the great diversity of manufacturers and models available in the Brazilian healthcare system. Despite their general similarities, each model has specific characteristics that, in many situations, demands a longer time to diagnose the defect and repair the equipment.During the period of the I+M initiative, the Reference Unit set up one workspace to receive, clean, and disinfect the mechanical ventilators and three maintenance laboratories, thus increasing its capacity to receive and recover more ventilators, so it also expanded the team dedicated to the project. The low availability of specialized technicians and engineers with knowledge of mechanical ventilation systems and equipment was an important bottleneck that the I+M initiative had to deal with.Despite the restrictions brought about by the pandemic, the initiative counted a representative number of professionals who volunteered to participate. In the case of the Reference Unit, at its peak, it had 37 people on the technical team focused on equipment repair, in addition to the logistics, management, and purchase teams.This productivity performance was also the result of applying tools from the lean philosophy, the principle of which is to do more with less waste, time, and resources . AdoptinIn total, the I+M initiative successfully repaired 2516 ventilators and returned them to healthcare units. Considering a theoretical number calculated at the maximum continuous capacity and assuming that, on average, a patient will require the continuous use of a mechanical ventilator for 15 days, in 6 months of use, the I+M initiative helped medical doctors and hospitals to support 30,192 human lives with mechanical ventilation.It is important to emphasize that, in an unprecedented way, other initiatives were observed around the world, such as the development of new ventilators that were easy to manufacture ,69; the In this work, an overview of the rapid deployment of a network for maintaining disused mechanical ventilators in public and private healthcare units is presented. The data show that the maintenance I+M at the Reference Unit had a large positive impact, covering more than five Brazilian states and directly affecting the treatment of a great number of patients. Many technological and logistical challenges were overcome. The implementation of the first line of ventilator maintenance in three days, meeting the protocols and norms, in partnership with clinical engineering professionals was a great challenge. Logistical structuring, from collecting ventilators to returning them to health units and developing procedures for cleaning and disinfecting equipment, was another great issue, in addition to the training of specialized labor for this type of action.The first maintenance unit was launched in three days with all required protocols and safetyThe engagement of SENAI institutes in the initiative allowed quick setup of new units once the institutes were present in all states in Brazil. Additionally, the interest of volunteers and industrial companies in supporting the initiative allowed knowledge transfer and financial support.The 2516 ventilators the initiative returned to healthcare units supported 30,192 human lives in the worst situation of the COVID-19 pandemic, considering a theoretical number calculated at the maximum continuous capacity.There was support in improving the infrastructure of the state hospital network and training of specialized labor for this type of action.The biggest challenges were the logistics, specialized manpower, and availability of spare parts to perform the maintenance.It is of fundamental importance to establish complementary criteria for the routine maintenance and management of spare parts for ventilators in public and private health networks, to ensure that ventilators remain usable for a long period of time. These aspects have a direct impact on the availability and reliability of equipment, and consequently on the ability to assist patients in treatment. In summary, the report provides the following information:


Introduction: As of March 2020, coronavirus disease 2019 (COVID-19) has been declared a “pandemic” by the WHO. This has led to the need for governments around the world to implement restrictive containment and isolation measures to stem the spread of the virus; these measures have included social distancing, isolation, and quarantine. The fear of contagion has been indicated as one of the causes of stress, anxiety, depression, and insomnia in the general population. With respect to the response of young people to the pandemic, the category of University students deserves further attention. The sudden change in “University” habits , the consequent loss of a social network, and the economic problems in their families have seriously affected the psychophysical well-being of University students. The aim of this study was to explore, in a sample of Italian University students, the relationships among anxiety, perceived vulnerability to disease, and smartphone use during the COVID-19 pandemic.Methods: A sample of 194 volunteer college students  aged between 18 and 30 years  were recruited to participate in this study. Participants were recruited through an online questionnaire sent to students of the University of Catania, Italy, and distributed from September 2020 to January 2021. The volunteer participants were given an online protocol that included the Fear of COVID-19 Scale (FCV-19S) for the evaluation of fear, the Perceived Vulnerability to Disease (PVD) for the evaluation of perceived vulnerability to disease, the State-Trait Anxiety Inventory (STAI) for the evaluation of trait and state anxiety, and the Smartphone Addiction Scale Short Version for Adolescents and Young Adults (SAS-SV) for the evaluation of use, abuse, or addiction of smartphone use.Results: The fear of COVID-19 did not reach an intensity such as to be defined as serious  in the whole sample. Both men and women showed a high risk of smartphone addiction  in SAS-SV. University students showed moderate trait and state anxiety  in STAI. In addition, students showed moderate perceived vulnerability to disease  in PVD. The results showed that fear of COVID-19 and trait anxiety appear to be the predictors of SAI and PVD but not the predictors of risk of smartphone addiction (SAS-SV).Conclusions: The data highlighted the presence of a perception of vulnerability to infections in subjects in which there was also a moderate anxiety, both state and trait, associated with the fear of the COVID-19 pandemic. It is hoped that a large part of the population will soon be vaccinated, including University students, and therefore, it would be desirable to carry out further assessments in the post-vaccine phase to highlight any differences in the state of anxiety and the perception of vulnerability to infections. The possible positive role of the use of smartphones in maintaining social contacts should also be emphasized. Coronavirus disease 2019 (COVID-19) has rapidly expanded in Europe, North America, Asia, and the Middle East. Based on the alarming levels of prevalence and severity, the Director-General of the WHO on March 11, 2020 called the COVID-19 situation a pandemic  axis and has shown how dangerous this is for the public, especially for pregnant women and disabled people  and emotional distress, individuals can cope better with the psychological and social threats of the pandemic if they can manage anxiety and depression, despite the high levels of fear of the pandemic infection , the consequent loss of a social network, and the economic problems in their families have seriously affected the psychophysical well-being of University students  were recruited to participate in this study. Participants were recruited through an online questionnaire sent to students of the University of Catania, Italy, and distributed from September 2020 to January 2021. The survey was also shared on the Facebook page of the Department of Educational Sciences of the University of Catania. All participants provided online informed consent and answered the questionnaire anonymously.A sample of 194 volunteer college students  aged between 18 and 30 years  for the evaluation of fear, the Perceived Vulnerability to Disease (PVD) for the evaluation of perceived vulnerability to disease, the State-Trait Anxiety Inventory (STAI) for the evaluation of trait and state anxiety, and the Smartphone Addiction Scale Short Version for Adolescents and Young Adults (SAS-SV) for the evaluation of use, abuse, or addiction of smartphone use.The FCV-19S  using SPSS software version 26.t-test of independent samples , and SAS-SV scales calculated through the  samples . There wThe Pearson's correlations are shown in The data from this study did not show significant differences regarding gender in the various assessment tests performed, except in the fear of COVID-19, in which women showed greater fear. Both male and female students showed a significant score for a high risk of smartphone addiction at SAS-SV, while the fear of COVID-19 did not reach a level to be defined as severe. Both state and trait anxieties showed a level of moderate severity, as well as a moderate perception of vulnerability to infections. Although the fear of COVID-19 cannot be defined as serious in the examined students, the correlations showed how, as the fear of the pandemic increased, both the aversion to germs and the perception of infections increased.Furthermore, the same variables  were also positively correlated with trait anxiety . We hypothesized that the trait anxiety highlighted in the examined subjects could have encouraged preventive and control behaviors toward the fear of contagion. It is significant to note that, although the use of smartphones can be defined as having a high risk of addiction, no significant correlations emerged between the latter and the other dimensions examined. Among other things, the PSU did not appear to depend on the fear of COVID-19.This seems to be in line with some other studies carried out on student samples during the COVID-19 pandemic. For example, the study by David and Roberts  conducteMoreover, some other studies on young adults showed that, although depression and social anxiety were the determinants of the risk for a greater PSU, particular categories of technological applications were positively correlated with psychophysical well-being (De Pasquale et al., Another significant finding that emerged from this study concerns the predictive value of fear of COVID-19 and trait anxiety on the perception of vulnerability to infections. Therefore, knowing in advance the psychological traits of the subjects, it is possible to intervene in time, preventing the negative influences of a particularly stressful event from becoming serious.This study has some limitations. In particular, the study reveals some methodological shortcomings, as the perception scales of vulnerability to disease have not typically been designed for clinical diagnostic purposes, diminishing their suitability for clinical research. Further study needs to be conducted to explore further phenomena that could be predicted by the constructs evaluated by the PVD. Furthermore, the sample of subjects examined is relatively small and concerns only a portion of University students in the city of Catania, even if the results of the study are quite consistent with the study carried out so far on University students in other countries during the COVID-19 pandemic. Another important limitation to consider concerns the fact that the state of the emotional well-being of these subjects is not known before the pandemic period, and therefore, we do not know for sure if the moderate state of anxiety found depends only on the effects of the pandemic or also on other variables. It is not possible to exclude states of anxiety and the presence of a certain degree of perception of vulnerability to infections preceding the pandemic due to the absence of evaluation.The data highlighted the presence of the perception of vulnerability to infections in subjects with moderate anxiety, both state and trait, to be associated with the fear of the COVID-19 pandemic. It is hoped that a large part of the population will soon be vaccinated, including University students, and therefore, it would be desirable to carry out further assessments in the post-vaccine phase to highlight any differences in the state of anxiety and the perception of vulnerability to infections. The possible positive role of the use of smartphones in maintaining social contacts should also be emphasized.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by Italian Association of Psychology. The patients/participants provided their written informed consent to participate in this study.CD: conceptualization, methodology, data curation, writing—original draft preparation, writing—review and editing, supervision, and funding acquisition. MLP: methodology, investigation, and writing—original draft preparation. FS: methodology, validation, formal analysis, investigation, and writing—original draft preparation. ZH: writing—review and editing, visualization, and supervision. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Dear Editor,Sweet Syndrome (SS) is the most frequent of neutrophilic dermatoses.We present a case of subcutaneous SS and BD in the same patient, given its extremely rare association.Mycoplasma pneumoniae serology, autoimmunity studies all negative. A skin biopsy revealed neutrophilic dermohypodermitis, mixed panniculitis, with vasculitis of the medium-small vessels (A healthy 72-year-old woman consults for painful erythematous nodules in the extremities of two weeks’ evolution, associated with fever and arthralgias. Physical examination reveals erythematous subcutaneous nodules on the extremities, arthritis, and oral ulcers . Laborat vessels . With thSubcutaneous SS fulfilled the same spectrum of neutrophilic panniculitis.There are few reports on the association of both dermatoses.We think that the relationship between both diseases is more than a mere coincidence. SS might represent a marker for Behçet’s activity, as in the majority of reported cases it presents in the acute phase or prior to an exacerbation, which is correlated to the clinical evolution of our patient.Future studies are needed aiming at the wide clinical variability of both diseases and the way they relate to each other, which is probably in a continuum within the spectrum of the still poorly understood neutrophilic dermatoses.None declared.Pablo Vargas-Mora: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analyzing, and interpreting the data; effective participation in research orientation; critical review of the literature; critical review of the manuscript.Fernando Valenzuela: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analyzing, and interpreting the data; effective participation in research orientation; critical review of the literature; critical review of the manuscript.Viera Kaplan: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analyzing, and interpreting the data; effective participation in research orientation; critical review of the manuscript.Laura Carreño: Approval of the final version of the manuscript; conception and planning of the study; obtaining, analyzing, and interpreting the data; effective participation in research orientation; critical review of the manuscript.None declared.


Science diplomacy is a fast-growing field of research, policy, and practice dedicated to understanding and reinforcing the connections between science and international affairs to tackle national, regional, and global issues. By aligning science and diplomacy, countries can attract talent, strengthen their national research ecosystems, provide avenues for participation of scientists in policy, and coordinate integrated solutions to challenges with technical dimensions. While Latin America has a long tradition of bilateral and regional cooperation, science still plays a marginal role in foreign policy, as has become evidenced by the response to the COVID-19 pandemic. With few exceptions, Latin American nations have a relatively immature science, technology, and innovation ecosystem, compounded by low public and private investments in research, coexisting with profound socio-economic inequalities, and large vulnerable populations. Such challenging conditions have created barriers to a fluid relationship between science and diplomacy, fundamentally characterized by inefficient communication between scientists and policymakers, weak collaboration channels, and duplicated roles, which altogether perpetuate siloed mentalities and a lack of trust between the two communities. Over the last decade, a first influential wave of Latin American scientists, diplomats, and other professionals, including five of the co-authors, have undertaken science diplomacy training provided by specialized organizations. Through these experiences, we recognized the need to elevate awareness and build capacities in science diplomacy in our respective countries and overall, across Latin America. Here, we describe emerging efforts and mechanisms to bridge the gap between scientists and policymakers at the national and regional level. Furthermore, we offer recommendations to amplify the impact of those pioneering initiatives toward consolidating a robust science diplomacy practice across the region. The national experiences described from Costa Rica, Mexico, and Panama can serve as a roadmap for other Latin American nations in the early process of developing a science diplomacy strategy, so they can also align themselves to a collective pathway. Most critically, we propose a way forward so that Latin America can leapfrog beyond disjointed training of individuals into integrated institutional strategies that can harness the tools of science diplomacy to enhance science-informed multilateral cooperation and enable more effective science-informed policymaking. Although science and diplomacy have been intertwined throughout modern history, the term was only coined in the early twenty-first century  ecosystem IDB, , compounSuch challenging conditions, along with deep ideological fractures, have created complex barriers to connecting scientific and diplomatic structures , The World Academy of Sciences , the European S4D4C project, the SciTech DiploHub (in Barcelona), the International Network for Government Science Advice , and the Innovation and Science Diplomacy School (InnSciDSP in São Paulo) , Mexico , and Panama (SLV) met at the 2017 edition of the Science Diplomacy and Leadership Workshop of the AAAS Center for Science Diplomacy, organized by MGS, then Senior Project Director at the AAAS Center for Science DiplomacyUpon our return from the program, we engaged with key science and policy stakeholders in our respective countries to help build and strengthen their science diplomacy ecosystems. Here, we present the journey of our countries—Costa Rica, Mexico, and Panama—in science diplomacy and document some of the advances and transformations we have contributed to and their impacts to date. Based on our experiences, we conclude by proposing suggestions for scaling capacities in science diplomacy across Latin America and provide recommendations to better integrate these pioneering initiatives into the sustainable development strategies of individual countries and the region as a whole.In Costa Rica, close collaborations between the scientific and diplomatic spheres have been ongoing for decades. As one of the first countries to demilitarize, Costa Rica prioritized resources for education, culture, healthcare, and environmental conservation, championing diplomacy, and peaceful engagement over hard power. Back in 1997 Costa Rica  proposed a model Nuclear Weapons Convention, in 2013 chaired the first Open-Ended Working Group on nuclear disarmament and eventually marshalled the Treaty on the Prohibition of Nuclear Weapons (TPNW) negotiation conference, which was adopted in 2017 Umaña, . Not surNevertheless, all these efforts only began to be labeled and recognized as “science diplomacy” after 2014, with the appointment of a scientist (Dr. Román Macaya) as Costa Rican Ambassador to the United States. In this role (a first for a scientist to be named ambassador), Dr. Macaya implemented an unprecedented agenda of scientific cooperation between the two countries, resulting in highly impactful collaborations in water, public health, disaster prevention, and remote sensing. In 2015, one such collaborative project linked researchers from the United States Geological Survey (USGS) with the Ministry of Environment and Energy (MINAE), leading to the production of high-resolution, country-scale remote-sensing mapping of underground aquifers  signed between the University in Costa Rica (UCR), the Costa Rican Social Security (CCSS), and George Mason University, originally designed to produce collaborations on infectious diseases such as zika and dengue, facilitated joint work in the formulation and testing of potential Covid-19 treatments during the 2020 pandemicOther science diplomacy efforts have leveraged strengths in local scientific production to shape diplomatic agendas. For example, research results from the Clodomiro Picado Institute were used as a basis for a 2016 proposal before the World Health Assembly, in pursuit of integrated global action to reduce deaths and disability caused by snake bites. This diplomatic initiative culminated in the 2017 declaration of snakebite poisoning as a priority neglected tropical disease by the World Health Organization (WHO) , began institutional efforts to link diplomats with researchers through regular convenings. Among the strengths in domestic scientific capacity, that could be leveraged to address relevant regional issues are the prevention of natural disasters through collaboration with the Volcanological and Seismological Observatory (OVSICORI), the conservation of marine biodiversity through the Center for Research in Marine Sciences and Limnology (CIMAR), and biotechnological development through the National Center for Biotechnological Innovations (CENIBiot). At the bilateral level, a recent example of transboundary science-based collaboration between foreign ministries is the joint submission of Costa Rica and Ecuador, requesting to extend their maritime boundaries over the continental shelf between the oceanic islands of Cocos (Costa Rica) and the Galapagos (Ecuador), with the added goal of jointly protecting pelagic species along the migratory passageway, which are threatened by illegal fishing in the areaIn order to formalize these interactions, which so far have been largely More recently, with heightened public awareness about the urgency to integrate science into foreign decision making, prompted by the Covid-19 pandemic, a series of virtual webinars were focused on science diplomacy. Last August, the UNESCO office in San José convened the first ever high-level panel in Costa Rica dedicated to the topic, featuring top representatives from the Ministry of Science and Technology (MICITT), the Ministry of Foreign Affairs, and other public entities. A more informal platform called Halo Sessions, geared toward informing the general public, also organized a webinar on science diplomacy in June 2020. Both of the Costa Rican co-authors (MG and ECA) participated in these events. And in early 2021, co-author MGS was invited by the Ministry of Foreign Affairs to present the results of her UNESCO report on science diplomacy in Latin America and the Caribbean to Costa Rican diplomats and invited scientists.Slowly, these incremental efforts are permeating into the institutional structures. However, many barriers still remain for early-career scientists to follow in Dr. Macaya's footsteps: just like in most countries STEM graduates are not traditionally exposed to science diplomacy curricula nor are there frequent spaces of interaction with diplomats. On the other hand, the Ministry of Foreign Affairs is currently developing a science diplomacy strategy, which would be formalized into the Process of Economic Diplomacy. Furthermore, they are actively seeking cooperation opportunities with science diplomacy e-training platforms that could provide courses on this topic to their personnel.Panama has a young science, technology, and innovation system, even if science and technical advances have been crucial since its early national development. Historical scientific institutions, such as the Smithsonian Tropical Research Institute (STRI) and the Gorgas Memorial InstituteIn 2017, the National Secretariat for Science, Technology, and Innovation (SENACYT), the science funding agency responsible for developing and strengthening the country's research and innovation systems, selected two young scientists from Panama (co-author SLV was one of them) to participate in the AAAS Science Diplomacy and Leadership Workshop. During our time in Washington DC, we met with a representative of the Panamanian Embassy and the discussion revealed the lack of communication between the diplomatic and the scientific spheres in Panama. It also manifested that most governmental institutions in Panama did not know much about the small but rapidly growing scientific community in the country, nor the breadth of domestic expertise in different scientific fields. Upon our return to Panama, we began conversations to raise awareness about science diplomacy among different stakeholders and institutions. SENACYT and the Ministry of Foreign Affairs (MOFA) approached the scientific community and international partners, including AAAS, UNESCO, and the Inter-American Institute for Global Change Research (IAI), to organize the first science diplomacy workshop in the country as a side event of the Latin American Open Science Forum (CILAC 2018), with the objective of raising awareness among scientists, diplomats, decision-makers, and journalists about the benefits and potential of science diplomacy to support the science system in Panama as well as the role of science to help meet the UN Sustainable Development Goals. Other Panamanian diplomats and scientists, many belonging to the Panamanian Association of the Advancement of Science (APANAC)In 2018 Panama became the first Latin American country to launch an official national strategy for science diplomacy, championed by former Vice President and Foreign Minister Isabel de Saint Malo, in coordination with SENACYT. The strategy establishes that the new diplomatic cadres must be familiar with science, technology, and innovation, and new institutional capacities must be created within Panama's foreign policy structures to align national and international policies with the 2030 Agenda. The action plan included the establishment of a Science Diplomacy Committee to foster dialogue and collaboration between the government and the scientific community. One of the key elements of the strategy was to incentivize the recruitment of STEM professionals to diplomatic careers, so Parliament updated the rules regarding the requirements for entry into the foreign service to open it to graduates from any background As the governance requirements of the science, technology, and innovation ecosystem grew, there was a need to create a dedicated office within the Mexican Government that would link the scientific community with policymakers more effectively. In 2013, the Science, Technology, and Innovation (STI) Office was established within the Office of the Presidency, elevating science advice to the highest political level.At this point, there was enough momentum within the scientific and policy communities, and opportunities to work between these two worlds started to materialize. Between 2012 and 2018, a new wave of young scientists interested in policy and diplomacy began to emerge, including co-authors AH and LM. We too participated in the 2017 AAAS Science Diplomacy and Leadership Workshop in Washington DC, where we connected with other scientists and diplomats from around the globe and joined a powerful network of collaboration and support. Back in Mexico, we started building bridges between our national research institutions and the international community, by fostering collaboration between the CCC, the President's STI Office, the National Council of Science and Technology (CONACYT), and international organizations such as AAAS1st Mexican Congress on Science-Informed Policy: Enhancing the Science-Policy InterfaceIn 2017, the STI Office, the CCC, and the AAAS Center for Science Diplomacy co-organized the The efforts to strengthen science-policy interfaces in Mexico were not limited to the Executive Branch. In the Federal Legislative Branch, an Office of Scientific and Technological Information for the Congress of the Union (INCYTU) was established and operated by the Scientific and Technological Consulting Forum (FCCyT) between 2016 and 2018. However, as it was external to Congress and financially dependent on the Executive, it had a modest impact and disappeared early 2019. In 2021, a new proposal has been passed to create an internal Office for Science Advice in the Chamber of the Deputies, which will depend on the Congress both financially and structurally. Additionally, the Federal Law of Science and Technology will be updated as a consequence of a Constitutional amendment. The objective of this law must include mechanisms for strengthening the institutional frameworks for the long-term development of science and technology, to consolidate the role of advisory bodies and research organizations such as the CCC, and to recommend the creation of new structures dedicated to science diplomacy and science advice not only in the executive and legislative branches, but in other levels of governance. An example at the sub-national level is a science policy fellowship program hosted by the Government of Mexico City (CDMX), led by AH and inspired in the AAAS Science Technology and Policy Fellowship (STPF), to place Ph.D. scientists in government offices for 1 year to develop knowledge and skills to navigate the science and public policy nexusThe COVID-19 pandemic response has manifested the divide between science, policy and society in many countries, and Latin America is no exception. Despite the promising advances presented here, our countries are still reactive, rather than anticipatory, to the challenges that require robust scientific input and regional and global cooperation. Governments must adopt this new vision of development and prosperity based on strengthening their science, technology, and innovation systems, and connecting knowledge to policy and society. Much more needs to be done to foster local and international cooperation to strengthen communication channels between scientists, diplomats, and policy makers. We show how the leadership of young pioneers, the co-authors being only few examples, supported by and trained in international programs have been a crucial first step to create a group of champions of science diplomacy in the region.First, national and regional institutions should take the lead in establishing regular capacity development in science diplomacy for scientists and diplomats, from junior to senior, rather than relying on external training opportunities in places like the United States or Europe. For science diplomacy to have a lasting impact in the development of the region, in resolving societal, environmental and health issues, it needs to go beyond one-off workshops, seminars, and conferences. Capacity development goes far beyond trainingOne national capacities are established, the next step will be the creation of a regional network of institutions dedicated to building science-policy interfaces, to collectively identify and tackle shared problems in the Latin American region. A pioneer effort in this direction is the Inter-American Institute for Global Change Research (IAI)'s Science, Technology, Policy (STeP) Fellowship ProgramWe must caution, however, against a too idealized vision of science diplomacy and recognize its limits and even potential negative consequences. Over the last 5 years, nations retreating from multilateralism, trust in science and expertise in decline, and increasing technological competition between major powers has challenged the “romantic view” that has dominated the mainstream discourse on science diplomacy (Rungius and Flink, All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


The prevalence of obesity, and its comorbidities, particularly type 2 diabetes, cardiovascular and hepatic disease and certain cancers, continues to rise at an alarming rate worldwide ,2. This Appetite and energy intake are modulated by a diverse range of factors—the latter are both ‘central’ and ‘peripheral’ ,6. The rDuring meal ingestion, the oral cavity is exposed to the texture, taste and smell of the food . As foodGiven the major advance in knowledge in the field, this Special Issue is timely, providing a comprehensive overview of the gastrointestinal mechanisms underlying the regulation of appetite and energy intake, as a series of definitive reviews by international authorities. These reviews address gut-related mechanisms, including nutrient sensing, gut hormones, gastrointestinal motility, gut-brain communication and the roles of the vagus, diet and the microbiota, as well as the abnormalities associated with eating disorders, specifically obesity and the anorexia of ageing. The reviews are divided into two sections; the first focuses on preclinical research, and the second on knowledge derived from studies in humans, including the implications for the management of metabolic diseases and eating-related disorders. The reviews are complemented by a number of important original papers.Lu and colleagues  discuss The subjective sensory experience of food, including its appearance, smell, taste and texture, is recognised to play an important role in the regulation of energy intake. Lasschuijt and colleagues  discuss The composition of a meal is detected in the oral cavity and throughout the lumen of the gastrointestinal tract. In addition to the four basic taste qualities, sweet, sour, salty and bitter, there is now evidence for the existence of additional tastes, including fat, umami, kokumi and carbohydrate. Keast and colleagues provide an overview of these tastes, their sensing in the oral cavity and gastrointestinal lumen, and their implications for food consumption . As a reObesity is characterised by dysregulations in the mechanisms controlling energy balance, including energy intake. Farhadipour and Depoortere review the evidence that gut hormone secretion is altered in obesity, reflecting changes in the functionality of gastrointestinal nutrient receptors and the effects of different weight loss strategies . That baThe review articles are accompanied by eight important original articles—the latter attest to the diversity of the work in this field. Preclinical studies investigated the effect of dietary supplementation with the amino acid isoleucine on body weight and blood glucose in lean and obese mice ; the effWe believe that this Special Issue provides a comprehensive overview of the gastrointestinal mechanisms contributing to appetite and energy intake regulation. Over the last decade, there have been substantial advances in our understanding of a number of areas—from the sensing of meal content, texture and palatability, signal transmission to the brain, signal processing and the translation into behavioural responses, through to the characterisation of dysfunctions in eating-related disorders, specifically obesity and the anorexia of ageing. Hence, while classically, the brain was viewed as the centre of appetite control mechanisms, it is now clear that many of the signals that activate the pathways involved in appetite control originate in the gastrointestinal tract. The powerful effects of bariatric surgery on gut hormone release, appetite suppression and sustained weight loss attest to this. The challenge for the next decade is to translate this knowledge, particularly that relating to the cellular mechanisms underlying nutrient sensing and gut hormone release, into effective dietary and pharmaceutical approaches for both the prevention and management of eating-related disorders.


The light-addressable potentiometric sensor (LAPS) is an electrochemical sensor based on the field-effect principle of semiconductors. It is able to sense the change of Nernst potential on the sensor surface, and the measuring area can be controlled by the illumination of a movable light. Due to the unique light-addressable ability of the LAPS, the chemical imaging system constructed with the LAPS can realize the two-dimensional image distribution detection of chemical/biomass. In this review, the advantages of the LAPS as a sensing unit of the microelectrochemical analysis system are summarized. Then, the most recent advances in the development of the LAPS analysis system are explained and discussed. In particular, this review focused on the research of ion diffusion, enzymatic reaction, microbial metabolism, and droplet microfluidics using the LAPS analysis system. Finally, the development trends and prospects of the LAPS analysis system are illustrated. The microfluidic chip is an emerging and powerful analysis technology, which has been widely applied in the development of microanalysis systems. In other words, based on the micro-electro-mechanical system (MEMS) technology, a variety of microstructures such as microchannels, micromixers, microreaction chambers, and micropumps are fabricated on glass, silicon wafers, organic polymers, and other materials. A series of discontinuous processes in biochemical analysis, including sample collection, processing, reaction, and detection, are integrated on a chip to achieve miniaturization and integration of the analysis equipment, which realizes lab-on-a-chip. Therefore, it has the advantages of fast analysis speed, less pollution, parallel processing, etc., and has gradually attracted more and more attention and has been applied in many fields such as clinical examination and environmental monitoring .The detector is one of the core components of a microfluidic chip. Since the advent of microfluidic chips, the research on detectors suitable for integration with microfluidic chips has been a hot spot. Among many microfluidic detection technologies such as electrochemical, titration, fluorophotometry, and colorimetry, electrochemical detection has shown many advantages such as a simple structure, small volume, no pollution to samples, and compatible with the micromachining technology, which have incomparable advantages in integration with chips , especiaScience, which pointed out that the LAPS can sensitively detect the weak change of the solid–liquid interface potential on the surface of the LAPS  how to improve the spatial resolution of LAPS records. The possible solutions may come from using novel semiconductor materials to manufacture LAPS chips, introducing more focused light spots, and laterally suppressing the movement of carriers in semiconductors. 2) How to speed up the imaging system. To solve this problem, it is necessary to utilize a high-speed scanning system, which allows rapid recording of data and rapid imaging from the sensor surface. 3) How to improve the measurement accuracy of the LAPS under microfluidic conditions. Since the measurements in the microscale or nanoscale solutions require very high accuracy, it is, thus, highly essential to improve the measurement accuracy of the LAPS, especially in the cases of high-throughput measurement. The possible solution to this problem may rely on the improvement of the peripheral circuits and data processing algorithms. In summary, it is necessary to further improve the spatial resolution, measurement speed, and accuracy of the LAPS to promote the wide applications of the microchannel analysis system in many fields such as biomedicine , food sa


Few scientists had the breadth and depth of scholarship, the keen interest in interdisciplinary scientific collaboration, and the commitment to mentoring the next generation of scientists as Dr. James Jackson. His passing remains a tremendous loss for the field. This symposium, organized by members of the Michigan Center for Urban African American Aging Research (MCUAAAR), which was founded by James over 20 years ago, reflects on the impact of transdisciplinary team science, of the importance of research networks and resource sharing, of the need to center research within practice and community, and of the scientific innovation that comes from integrating conceptual models, data sources, and methodological approaches from seemingly disparate fields. The session is co-chaired by Dr. Robert Taylor, longtime faculty member and current PI of MCUAAAR. The talk by session chair Dr. Briana Mezuk will discuss the ways in which the training approach of Analysis Core has inspired new training programs on integrative methods focused on minority health and disparities. The talk by Dr. Tam Perry will describe the innovations of the Community Liaison and Recruitment Core, including how COVID-19 impacted the activities of the Healthier Black Elder Center. The third talk by Dr. Rodlescia Sneed, a MCUAAAR early-career scientist, provides an example of how this Center supports interdisciplinary minority aging research through her project focused on older adults who have a history of incarceration. Finally, Discussant Dr. Roland Thorpe, a member of the MCUAAAR Advisory Board, will reflect on Dr. Jackson’s legacy of mentorship and collaboration.