In the published article, there was an error in the Funding statement:This work was partially supported by VetzPetz Asia Company and Chiang Mai University (CMU) , which provided the necessary budget through the Center of Excellence in Veterinary Biosciences, Faculty of Veterinary Medicine, Chiang Mai University, R000029941 (WP), and the Faculty of Veterinary Medicine, Chiang Mai University . The authors declare that this study received funding from VetzPetz Asia Company. The funder was not involved in the study design, collection, analysis, interpretation of data, the writing of this article or the decision to submit it for publication.The correct Funding statement appears below.This work was partially supported by Pharmalink International Limited and Chiang Mai University (CMU) , which provided the necessary budget through the Center of Excellence in Veterinary Biosciences, Faculty of Veterinary Medicine, Chiang Mai University, R000029941 (WP), and the Faculty of Veterinary Medicine, Chiang Mai University . The authors declare that this study received funding from Pharmalink International Limited. The funder was not involved in the study design, collection, analysis, interpretation of data, the writing of this article or the decision to submit it for publication.The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.


BackgroundThe Preventive Health and Screening Outpatient Department (OPD) was started in Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India with the vision of promoting health , counseling, screening, early diagnosis, and treatment and referral services (secondary prevention). The objective of the study is to describe the process of establishing the Preventive Health and Screening OPD in a tertiary hospital in Delhi and illustrate the functioning of the newly established OPD.MethodologyThis study is based on observation of the day-to-day functioning of the OPD, record checking of registers, and reviewing the records of the hospital registration system. Here, we describe the functioning of the OPD from its initiation in October 2021 until December 2022.ResultsThe routine services provided at the OPD include health promotion and education, especially focusing on non-communicable diseases, screening, diagnosis, treatment, lifestyle counseling; general OPD services; growth monitoring and counseling; group discussion for harms of tobacco usage; counseling for tobacco cessation, hepatitis B, and dT vaccination; group counseling for antenatal women; and screening for breast cancer. A few events such as the breast cancer screening camp and the non-communicable disease screening camp were also conducted under the purview of the new OPD. Such OPDs are the need of the hour for the provision of comprehensive healthcare, including promotive and preventive healthcare, along with curative health services, at tertiary healthcare levels.ConclusionsHealthcare services are incomplete without the preventive, promotive, and screening components of healthcare. For mainstreaming health promotion and preventive healthcare, Preventive Health and Screening OPDs are essential at hospitals. The benefits of prevention extend beyond managing chronic diseases and longer lives. Three levels of prevention and five levels of preventive interventions, as promoted by Leavell and Clark, are taught in all healthcare institutions under the concept of health and disease . “PrevenEvidence has proved that investment in public health is more efficient and effective than an emphasis on curative and rehabilitative services -9. The hThe objective of the study is to describe the process of establishing a unique outpatient department (OPD), the Preventive Health, and Screening Outpatient Department, in a tertiary hospital in Delhi, and illustrate the functioning of the newly established OPD. The Preventive Health and Screening OPD was started in Vardhman Mahavir Medical College and Safdarjung Hospital by the Department for Community Medicine for promoting health and preventive measures at the tertiary healthcare level.The present study is a descriptive account involving meticulous observation and review of hospital records. The initiation process of the OPD has been delineated through a comprehensive analysis of the proposal (for the establishment of the OPD) and minutes of the meeting register. Furthermore, data collection was conducted through daily observations of the OPD’s operational functioning. In addition, hospital registration reports spanning a period of 15 months, from October 2021 to December 2022, were thoroughly reviewed for data analysis and reporting purposes.Establishment of the Preventive Health and Screening Outpatient DepartmentThe inception of the Preventive Health and Screening OPD at Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, was formulated with the vision of promoting health , screening, early diagnosis and treatment (secondary prevention), counseling, and referral services. The intention of establishing such an OPD was set in motion by the Department of Community Medicine. The proposal was discussed among the faculty of the department. Debates and discussions regarding the selection of services, functioning of the OPD, the utility of such an OPD, the demand of the OPD, and logistics requirements followed. The priority areas were marked, and the services list was finalized for the OPD. After repeated persuasion, with the support of the Medical Superintendent and the Ministry of Health and Family Welfare, Government of India, the OPD was started in the new OPD building of Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, in September 2021. The staff posted in the OPD is listed in Table The OPD has delivered health care to its beneficiaries for more than 15 months until December 2022. This has been mediated by conducting health education sessions, group and individual counseling of beneficiaries, screening of high-risk groups, and, per demand, diagnosis and treatment of common illnesses, non-pharmacological interventions, lifestyle counseling, adult vaccination, and referral to other departments. Citizen charters were put up at different locations in the hospital to inform about the new OPD and its services. Beneficiaries in the OPD were either walk-in patients, referred from other departments or from the field practice areas, and referred cases from peripheral clinics of the Department of Community Medicine. The flow of OPD services is illustrated in Figure Non-communicable disease screening, diagnosis, and treatment and lifestyle counselingOpportunistic screening for diabetes, hypertension, oral cancer, and breast cancer was conducted for all walk-in patients aged 30 and above. Under the purview of occupational health checkups, all security guards employed in the hospital were screened for diabetes, hypertension, and oral cancer. During the screening, a history of diet, medication, and addiction was also obtained. The guidelines followed for the screening and management of the beneficiaries were in accordance with the guidelines issued under the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke, Ministry of Health and Family Welfare, India. All beneficiaries with elevated blood pressure and blood glucose level were followed up and provided treatment and counseling for lifestyle modification. All patients were explained about diet, exercise, frequency of follow-up visits, the importance of treatment adherence, blood investigations, possible disease complications, and ways to prevent the complications. If required, patients were referred to other specialized departments.General outpatient services Patients with common illnesses were treated according to standard treatment protocols. For chronic non-communicable diseases such as diabetes, hypertension, and osteoarthritis, lifestyle modification was emphasized, along with pharmacological treatment. Patients were also explained the importance of treatment compliance and regular follow-up visits. Opportunistically, patients were educated about the dangers of antibiotic abuse and were discouraged from the use of over-the-counter antibiotics. For all patients, non-pharmacological interventions were equally highlighted as the pharmacological part of the treatment during the counseling.Group discussion for harms of tobacco usage and counseling for tobacco cessationAll security guards, sanitation workers, and nursing attendants in the hospital were provided health education on the harms of tobacco usage in group counseling sessions. All tobacco users, identified during non-communicable disease screening, were registered for tobacco cessation. All counseling sessions were conducted with the help of a validated flipchart. Patients were referred to the Department of Psychiatry if indicated.Adult vaccination centerA center was established for adult vaccination where hepatitis B and dT vaccinations were regularly provided at the OPD. First-degree relatives of hepatitis B patients were counseled about the ways of transmission and prevention of hepatitis B. All hospital staff was encouraged to get regular doses of hepatitis B and flu vaccines according to schedule.Health promotion and health educationResident doctors and interns posted at the OPD conducted regular health education sessions about relevant topics using flipcharts at the OPD premises and the waiting areas of the hospital.Group counseling for antenatal womenGroup counseling sessions for antenatal women were conducted in the OPD, with the help of a PowerPoint presentation. The beneficiaries were explained about medication intake, diet, rest, contraindications during pregnancy, birth preparedness, breastfeeding, postnatal care, and family planning. At the end of the counseling, the queries of the beneficiaries were addressed. All antenatal women were screened for any anomaly of the nipple which might cause difficulty in breastfeeding.The well women clinicAll women above 30 years of age were screened for breast and cervical cancer. This service was conducted in coordination with the Department of Obstetrics and Gynaecology. The beneficiaries were also taught about self-breast examination. Beneficiaries who screened positive for breast lumps were referred to the Department of Surgery.Growth monitoring and counselingA total of 33 children were found to be malnourished after screening in 15 months. They were screened for anemia and other common illnesses. Along with treatment, their attendants were counseled on the diet and care of the children.After 15 months of functioning of the OPD, the total number of beneficiaries of different services is presented in Table The Preventive Health and Screening OPD aimed at achieving health in a holistic way. Hence, apart from the above-mentioned services, a few special events were conducted by the Department of Community Medicine, at the OPD premises.In November 2021, a blood sugar screening camp was conducted on the occasion of World Diabetes Day. A total of 214 people were tested. Among them, 32 individuals were found to be diabetic who were unaware of their status. In total, 29 people were found to have uncontrolled blood glucose levels. All diabetic patients were treated and informed about the dietary and lifestyle changes at the Preventive Health and Screening OPD.On the occasion of International Women’s Day, the Department of Community Medicine and the Department of Obstetrics and Gynaecology, Vardhman Mahavir Medical College and Safdarjung Hospital, in collaboration with the Association of Obstetricians & Gynaecologists of Delhi conducted Women Cancer Screening Fortnight. A total of 70 women visiting the hospital were screened for cervical  and breast cancer . Moreover, their knowledge of cervical and breast cancer was assessed. They were educated on the risk factors, symptoms, preventive measures of cervical and breast cancer, and self-breast examination.On the occasion of International Day of Yoga 2022, the Central Council for Research in Yoga and Naturopathy, Ministry of AYUSH, Government of India along with the Department of Community Medicine, conducted an event with the theme “Yoga for Humanity” at the Preventive Health and Screening OPD. The standard Yoga protocol was demonstrated. The program was attended by around 150 participants comprising MBBS interns, faculty employees, security staff, and nursing staff.A refresher training session about anti-rabies vaccination was held in the OPD. The participants included nurses, postgraduate trainees, junior residents, and interns. An interactive discussion about the vaccination schedule, indications, and challenges was conducted. Queries of the staff posted at the Rabies Vaccination Clinic were addressed at the end of the session.Safdarjung Hospital, a 1,531-bedded multi-specialty with an additional 500 emergency beds, is one of the largest tertiary care teaching hospitals in India. It is a Central Government Hospital under the Ministry of Health & Family Welfare, Government of India. The hospital has a monthly OPD attendance of approximately 200,000 which includes patients from all age groups, socioeconomic strata, and disease spectrum from all over India. Patients are mostly accompanied by one or more attendants. This heavy footfall provides an opportunity to cater promotive and preventive care to them within a tertiary care setup. With almost 10,000 patients per working day, there are time constraints faced by treating physicians as well as supporting paramedical staff to provide detailed health education and health promotion advice to patients.Health education regarding the prevention of diseases, lifestyle modification, and overall health promotion is an important component of disease management and holistic health improvement. Such advice should be given in a detailed manner and should be personalized to the patient’s illness, risk factors, and level of understanding to ensure the proper transfer of information and improve compliance. Such advice assumes greater importance in the context of non-communicable diseases because these diseases are influenced by modifiable lifestyle factors to a great extent. Properly disseminated health information and health promotion advice has the potential to prevent non-communicable diseases, earlier detection, and/or reduce complications of such diseases. In addition, screening for non-communicable diseases is important in the Indian scenario because of the lack of awareness and regular screening. Such screening helps in the earlier detection of non-communicable diseases and ensures better treatment and control while reducing potential complications. Similarly, antenatal care also requires counseling for lifestyle modification apart from medicinal treatment. Growth monitoring of under-five children and advice for defaulters also require individual counseling and guidance.Preventive care services can promote healthier lifestyles, provide early detection of diseases, and reduce the need for inpatient care services among individuals . A similThe private healthcare sector is presently catering to the increasing demand for preventive healthcare -16. The Our study is not without limitations. Because our study is review and observation-based, it suffers from the inherent problem of incomplete and inconsistent existing data. The study elaborates on a period of the initial 15 months. It is limited by the timeframe of data collection, which may not capture changes or trends that occur outside of the study period.Healthcare services are incomplete without the preventive, promotive, and screening components of healthcare. The benefits of prevention extend beyond managing chronic diseases and longer lives. For mainstreaming health promotion and preventive healthcare, Preventive Health and Screening OPDs are essential at hospitals. Tertiary hospitals being the apex centers in our country should attend to their beneficiaries holistically beyond the narrow purview of curative medicinal practice. Research should be encouraged for assessing the feasibility of the implementation of such OPDs, exploring barriers, ways to awareness and demand among the community for the services, and improving the effectiveness of such OPDs.


The frequent occurrence of pig epidemics has restricted the sustainable and healthy development of the pig industry and its ability to enhance the supply of pork, negatively impacting China’s economic and social development. In recent years, China has faced many pig epidemic risks and challenges, with one high-risk area and two medium–high-risk areas. The epidemic risk was highest in Beijing, Hainan, Liaoning, Tibet and Zhejiang. This study will help to better prevent and mitigate epidemic risks, promote high-quality development of the pig industry, and meet the nutritional needs of residents.Strengthening the analysis and risk assessment of the pig epidemic will help to better prevent and mitigate epidemic risks and promote the high-quality development of the pig industry. Based on a systematic understanding of live pig epidemics, a risk assessment index system was constructed, and the spatial and temporal variation characteristics of pig epidemics in China were explored by the entropy method. In recent years, the overall trend in pig epidemics over time first increased and then decreased; in space, the acceleration of the spread of epidemics across the country weakened. China still faces challenges, including many types and a wide range of diseases, large total livestock breeding and weak epidemic prevention and control capacity, and a large risk of introduced foreign animal epidemics. The spatial and temporal variations in the pig epidemic risk were obvious; one high-risk area, two medium–high-risk areas and 10 medium-risk areas have been found in recent years, during which time, the epidemic risk was highest in Beijing, Hainan, Liaoning, Tibet and Zhejiang. However, there were significant differences in the regional distribution of the risk level of pig epidemics in different years. To further build a secure “defense system” for the high-quality development of the pig industry, it is recommended to improve the monitoring and early warning system of pig epidemic risk, perfect the pig epidemic prevention and control system, and strengthen the regional collaboration mechanism of epidemic prevention and control. Accelerating the high-quality development of the pig industry and ensuring the stable and orderly operation of the pork market is an important means of meeting the animal-based nutrition needs of residents and safeguarding national food security. This is a basic guarantee for enhancing the level of regional economic and social development, improving the ability of farmers to increase production and income and forging a realistic path for accelerating the construction of an agricultural powerhouse and realizing people’s aspirations for a better life. In recent years, the frequent occurrences of African swine fever and other major animal epidemics have restricted the sustainable and healthy development of the pig industry and its ability to enhance the supply of pork, negatively impacting national economic and social development and the lives of urban and rural residents. Although, currently, incidences of African swine fever and other major animal epidemics have been alleviated, sporadic occurrences, as well as epidemic prevention and control, cannot be ignored. Data from the Ministry of Agriculture and Rural Affairs of the People’s Republic of China showed that 15 new outbreaks of African swine fever occurred nationwide in 2021, and 4500 pigs were killed and disposed of. Since then, China’s government has attached great importance to the construction of national biosafety risk prevention, control and management systems; it has become inevitable and necessary to carry out risk assessment and systematic research on major animal disease prevention and control as an important part of the national biosafety risk prevention and control system.The literature on animal disease risk is primarily focused on risk assessment, animal disease prevention and control, etc. . In termThe issues of domestic animal disease transmission risk and international trade disease transmission risk have also been explored in many studies ,16,17. SOther studies have suggested that to achieve the stable and orderly development of the pig industry, the important role of epidemic prevention and control must be given high priority in building a long-term mechanism ,28. FromIn general, with the current focus on African swine fever, the research that specifically analyzes this situation and risk assessments of pig epidemics needs further systematic and in-depth review. In particular, after African swine fever outbreaks, it is of great practical importance to review the circumstances of the pig epidemic, systematically explore the spatial and temporal variation characteristics associated with the risk level of the pig epidemic, and summarize the lessons learned to better improve the epidemic prevention and control system, prevent and resolve the epidemic risk, and promote the high-quality development of the pig industry in the future. Considering the shortcomings of existing studies, this study attempted to construct a pig epidemic risk assessment index system based on an understanding of pig epidemic circumstances starting in 2017; use the entropy method to assess the epidemic risk and understand the spatiotemporal characteristics; and, finally, propose corresponding countermeasure suggestions for reference.Animal epidemics are an important factor that restricts the smooth and orderly development of the pig industry; epidemics with greater impacts mainly include porcine reproductive and respiratory syndrome and African swine fever. Regarding the trend of pig epidemics in recent years, after 2018, affected by African swine fever, the number of cases, deaths, and cullings increased sharply. Afterward, as the epidemic prevention and control situation continued to improve, the pig epidemic gradually slowed down . In termBefore the African swine fever outbreaks, pig epidemics were mainly distributed in Jiangxi, Hubei, Chongqing and Guangxi provinces, while the number of cullings was generally at a relatively low level. After the outbreak of African swine fever, the regional distribution of the epidemic changed significantly, with concentrated outbreaks in various regions. In 2018, the top three provinces in terms of cases were Jiangxi, Yunnan and Sichuan, the top three provinces in terms of deaths were Liaoning, Yunnan and Chongqing, and the top three provinces in terms of cullings were Liaoning, Hunan and Fujian. In 2019, the regional distribution of the epidemic changed further, with the top three provinces in terms of cases and deaths being Guangxi, Sichuan and Heilongjiang, and the top three provinces in terms of cullings being Heilongjiang, Jiangsu and Guangxi. Since 2020, with the African swine fever epidemic under better control, the national pig epidemic situation has continued to improve, and only Gansu Province’s pig epidemic has been relatively serious. Overall, the regional distribution of pig epidemics in recent years was mainly affected by African swine fever, and with the African swine fever epidemic under control, pig epidemics have rapidly slowed nationwide. Currently, pig epidemics occur only sporadically in some provinces .At present, although African swine fever and other major animal diseases are better controlled, the associated risks and challenges are still prominent. First, pig epidemics are diverse and widespread. According to the “List A, B and C Diseases” issued by the Ministry of Agriculture and Rural Affairs of the People’s Republic of China in 2022, there are currently a wide variety of pig diseases in China, such as A diseases, including African swine fever, foot and mouth disease, and swine vesicular disease. At present, a large number of pig diseases occur sporadically, and complete elimination is still far off. In terms of the speed and scope of the spread, African swine fever, for example, was first diagnosed in Liaoning Province in August 2018, and then the epidemic spread rapidly across the country within a short period of time, tremendously and negatively impacting the pig industry and market as well as the economy and society. The pig slaughters in 2019 fell by 21.6% compared with the previous year, and pork production dropped by 21.3%.Second, the total amount of livestock breeding was large, and the epidemic prevention and control capacity was not strong. China is the world’s largest producer and consumer of pigs, and since the outbreak of African swine fever in 2018, China’s government has implemented a series of policy initiatives to accelerate the recovery of pig production to normal levels. The inventory of pigs reached 452.56 million heads in 2022, of which the inventory of breeding sows reached 43.90 million heads. Although the level of scale, intensification and modernization of pig breeding has improved, there is still a large gap between the expected goal of high-quality development and the levels of developed countries in terms of epidemic prevention and control capabilities. There are still more small and medium-sized farms, retail households and other business entities in which the awareness and ability regarding epidemic prevention and control are not strong, and the level of epidemic prevention and control of pig households needs further improvement. In addition, the current grassroots epidemic prevention and control system is not sound, the epidemic prevention team is relatively weak, and loopholes in quarantine supervision and other issues remain prominent. In China, where people prefer hot fresh meat, the long-distance transport and slaughter of live pigs also create uncertainty about the spread of pig epidemics.Moreover, the risk of introduction of foreign animal diseases is greater. At present, the global situation of pig epidemics is still not optimistic. Data from the World Organization for Animal Health (WOAH) showed that in 2022, there were 6026 new outbreaks of African swine fever worldwide, with 159.80 thousand newly confirmed cases, 199.90 thousand heads killed and disposed of, and 38.50 thousand deaths. Although China has been strictly controlling foreign animal epidemics for a long time, including with the development and implementation of the “Emergency Response Plan for Major Animal Epidemics Inside and Outside China” and “Interim Measures for Veterinary Health Management of Animal Isolation and Quarantine Sites at Ports” and other policy initiatives, it still failed to block the introduction of animal diseases such as African swine fever into China. It is necessary to pay great attention to the variety of global animal diseases, the complexity of the pathogens and the seriousness of these situations and other issues; to learn from the current round of African swine fever regarding domestic exposures; to accelerate sound domestic animal disease prevention and control systems; and to reduce the risk of foreign disease introduction to protect the high-quality development of the pig industry.To systematically assess the risk of pig epidemics and explore their spatial and temporal risk characteristics, this study constructed an evaluation index system and combined it with the entropy method. In defining the concept of risk assessment, the United Nations Office for Disaster Risk Reduction considers that risk consists of two parts: hazard and vulnerability . CombiniSpecifically, the morbidity rate was measured by the ratio of the number of cases caused by the epidemic to the number of pigs, the mortality rate was measured by the ratio of the number of pig deaths caused by the epidemic to the number of cases, and the culling rate was measured by the ratio of the number of pigs culled during the epidemic to the number of pigs. The higher the three indicators were, the more serious and dangerous the pig epidemic was. In particular, unlike morbidity and mortality rates, the culling rate was more indicative of the severity of the epidemic, such as the occurrence of African swine fever in recent years, which caused a higher culling rate, and although the realistic mortality rate was not high, a large number of pigs were culled due to factors such as the high lethality and rapid spread of African swine fever.Breeding density was measured by the ratio of pig inventory to grain cultivation area. Pigs are grain-fed livestock, and a higher breeding density indicates a higher local pig carrying capacity and a higher epidemic risk faced by pig breeding. Industrial structure was measured by the ratio of pig industry output value to total agricultural output value. The higher the proportion of pig industry output value is, the more likely the pig industry is the leading industry in the province, the higher the corresponding scale of standardization and modernization, and the lower the epidemic risk faced by pig breeding. The prevention and control foundation was measured by the ratio of pig inventory to the number of people on staff in township animal husbandry and veterinary stations. The higher the ratio of pig inventory to the number of staff in the township animal husbandry and veterinary station is, the more pigs a single animal husbandry and veterinary staff member has to manage and serve, the weaker the force of pig epidemic prevention and control, the lower the intensity of epidemic prevention and control, and the greater the risk of an epidemic affecting pig breeding.ijx is the value of hazard and vulnerability indicators after normalization, ija is the original value of each hazard and vulnerability indicator, and max{ija} and min{ija} are the maximum and minimum values of each hazard and vulnerability indicator, respectively.Considering the differences in different indices in terms of their outlines and positive and negative directions, this study first standardized the indices, then calculated the index weights at all levels by the entropy method, and finally combined the standardized index values and weights to calculate the pig epidemic risk index. It should be noted that the morbidity rate, mortality rate, culling rate, breeding density and prevention and control foundation were all positive indicators, while industry structure was a negative indicator. The standardized treatment formula is specified as follows:ith region under the jth indicator needs to be calculated as follows:ijp is the corresponding indicator weight. Then, the entropy value of the jth indicator is calculated:je is the entropy value of the corresponding indicator and satisfies je≥ 0, k = 1/lnn. On this basis, the weights of each indicator are calculated as follows:jw is the corresponding indicator weight, jd is the information entropy redundancy of the jth indicator, and jd= 1 − je.Before calculating the weights of each indicator through the entropy method, the weight of the corresponding indicator of the The data for this study were obtained from the Official Veterinary Bulletin of the Ministry of Agriculture and Rural Affairs of the People’s Republic of China, China Animal Husbandry and Veterinary Yearbook, and China Statistical Yearbook. Considering that the Official Veterinary Bulletin from the Ministry of Agriculture and Rural Affairs of the People’s Republic of China was available only for October 2021 and earlier, the pig epidemic data for 2021 were only for January–September. Therefore, the time interval examined in this study was set as 2017–2020, where 2017 was the normal year before the outbreak of African swine fever, 2018–2019 was the most serious period of African swine fever, and 2020 was the year when the epidemic was better controlled. Overall, the time interval selected in this study covered the current round of the pig epidemic, and the pig industry in each region and its impact could better reflect the corresponding epidemic risk prevention and control capacity and its problems.Combined with the basic data, the indices of pig morbidity, mortality and culling rates, breeding density, industrial structure, and prevention and control foundation from 2017 to 2020 were calculated, and the risk of a pig epidemic and its hazard and vulnerability indices were calculated after standardization. Specifically, the hazard and vulnerability weights calculated by the entropy method for 2017–2020 were 0.679 and 0.321, respectively; the hazard indicators were 0.243, 0.105 and 0.652 for morbidity, mortality and culling rates, respectively; and the vulnerability indicators were 0.393, 0.125 and 0.482 for breeding density, industrial structure and prevention and control foundation, respectively. The weights of each indicator reflected that the risk of a pig epidemic came more from hazards, the culling rate regarding hazard factors was more important, and the foundation of prevention and control of vulnerability factors was more important. Regarding the characteristics of the regional distribution of pig epidemic risk, the top five provinces were Beijing, Hainan, Liaoning, Tibet and Zhejiang, with risk indices of 0.682, 0.367, 0.337, 0.282 and 0.268, respectively. The bottom five provinces in terms of risk were Shandong, Hebei, Jilin, Ningxia and Inner Mongolia, with risk indices of 0.097, 0.104, 0.112, 0.118 and 0.125, respectively.In terms of hazards, the top five provinces were Beijing, Liaoning, Tibet, Qinghai and Jiangxi, with hazard indices of 0.799, 0.361, 0.329, 0.281 and 0.266, respectively. The bottom five provinces were Shandong, Guangdong, Henan, Hebei and Guizhou, with risk indices of 0.006, 0.017, 0.052, 0.052 and 0.07, respectively. Among them, the top provinces in terms of morbidity rates were Jiangxi, Chongqing, Qinghai, Tibet and Zhejiang, the top provinces in terms of mortality rates were Jilin, Qinghai, Inner Mongolia, Liaoning and Heilongjiang, and the top provinces in terms of culling rates were Beijing, Liaoning, Tibet, Tianjin and Xinjiang.In terms of vulnerability, the top five provinces were Hainan, Fujian, Guangdong, Guangxi and Zhejiang, with vulnerability indices of 0.962, 0.566, 0.460, 0.439 and 0.438, respectively. The bottom five provinces were Jilin, Inner Mongolia, Heilongjiang, Shanxi and Ningxia, with vulnerability indices of 0.118, 0.122, 0.147, 0.148 and 0.149, respectively. The top provinces in terms of breeding density were Hainan, Fujian, Beijing, Guangdong and Guangxi; the top provinces in terms of industrial structure were Hunan, Yunnan, Sichuan, Anhui and Chongqing; and the top provinces in terms of prevention and control foundations were Hainan, Henan, Zhejiang, Anhui and Fujian. In terms of the overall situation of the risk of pig epidemics in different areas in recent years, there was 1 high-risk area, 2 medium–high-risk areas, 10 medium-risk areas, 17 medium–low-risk areas and 1 low-risk area nationwide. The risk of pig epidemics and regional prevention and control should not be ignored.Regarding the trend in temporal changes in the risk of pig epidemics, the regional changes in the risk of pig epidemics in different years were obvious. Before the outbreak of African swine fever in 2017, the provinces with the highest risk of pig epidemics were Qinghai, Jiangxi and Chongqing; the risk was also relatively high in northwest, southwest and southeast China; and the risk was low in northeast and north China. There were three high-risk areas, no medium–high-risk areas, and three medium-risk areas, and the others were medium–low- and low-risk areas. In 2018, with the outbreak of African swine fever, the regional distribution of pig epidemic risk changed significantly, mainly concentrated in Beijing and Liaoning, with Zhejiang, Tianjin and Jiangxi also at relatively high levels, and the overall risk of pig epidemics shifted to the east. There was one high-risk and medium–high-risk area and three medium-risk areas, and the remaining areas were low-risk and medium–low-risk areas.The year 2019 was a more severe year for the occurrence of African swine fever, and the risk of pig epidemics spread faster across the whole country. The highest risk of epidemics shifted to Tibet and Jiangsu; the epidemic risks in Qinghai, Xinjiang and Heilongjiang were also relatively high. There were two high-risk areas, three medium–high-risk areas, and two medium-risk areas, and the remaining areas were low- and medium–low-risk areas. In 2020, with the African swine fever epidemic under better control, the risk of pig epidemics in China slowed. Gansu and Shanghai had the greatest epidemic risks and were high-risk and medium–high-risk areas; the risks in other areas were relatively low, and there were 26 low-risk areas.In general, the spatial and temporal variation in pig epidemic risk was the result of multiple factors. This study focused on two aspects: the occurrence and spread of pig epidemics and the spatial and temporal variation in epidemic prevention and control. From the perspective of the occurrence and spread of pig epidemics, the higher the mortality rate was, the faster the spread, the more serious the situation, the greater the risk of pig epidemics, and the more obvious the risk spillover effect to other regions.Taking African swine fever as an example, the mortality and culling rates caused by the national pig epidemic in 2018–2019 were 41.97% and 0.49% and 40.95% and 0.19%, respectively, much higher than the respective 21.50% and 0.001% in 2017 before the African swine fever outbreak. Among them, the highest culling rate was 7.64% in Beijing in 2018 and 2.16% in Tibet in 2019, which was consistent with the regional distribution and annual changes in the risk of pig epidemics. In terms of spatial and temporal differences in pig epidemic prevention and control, factors such as breeding density, industrial structure, and prevention and control foundation were closely related to the risk of an epidemic; the greater the breeding density was, the more vulnerable the industrial structure, and the poorer the prevention and control foundation was, and the more serious the risk faced by pig breeding. In terms of breeding density, the highest was 10.73 heads/ha in Hainan, and the lowest was 0.72 heads/ha in Inner Mongolia. The risk of pig epidemics in Hainan was obviously higher than that in Inner Mongolia. In terms of industrial structure, the highest was 19.65% in Hunan, the lowest was 1.40% in Tibet, and the risk of pig epidemics in Tibet was higher than that in Hunan. In terms of prevention and control foundation, each township animal husbandry and veterinary station in Hainan Province needed to serve 21,086.40 pigs, while the corresponding indicator in Tibet was only 136.94 pigs. The pressure of prevention and control in Hainan was significantly greater than that in Tibet, so the corresponding risk of pig epidemics in Hainan was higher than that in Tibet.On the basis of understanding the situation of pig epidemics, the following research conclusions were obtained by constructing a pig epidemic risk assessment index system and combining it with the entropy method to explore the characteristics of spatial and temporal differentiation of pig epidemic risk in China.First, the overall trend in pig epidemics first increased and then decreased. African swine fever was the most serious epidemic in recent years, and swine erysipelas, swine pasteurellosis, porcine reproductive and respiratory syndrome, classical swine fever and other pig diseases were also more common. Pig epidemics showed a trend of accelerated spread nationwide after continued weakening and now have only sporadic occurrences in some areas. Although African swine fever and other pig diseases are better controlled, the risks and challenges, which include many types and a wide range of diseases, cannot be ignored. Livestock breeding and epidemic prevention and control capacity were not strong during the study period, and the risk of introduction of foreign animal diseases was greater.Second, the spatial and temporal variation in pig epidemic risk was obvious. In 2017–2020, there was 1 high-risk area, 2 medium–high-risk areas, 10 medium-risk areas, 17 medium–low-risk areas and 1 low-risk area. The top five provinces in terms of pig epidemic risk were Beijing, Hainan, Liaoning, Tibet and Zhejiang, and the bottom five provinces were Shandong, Hebei, Liaoning, Ningxia and Inner Mongolia. There were significant differences in the regional distribution of epidemic risk in different years, with the high-risk areas being Qinghai, Jiangxi and Chongqing in 2017, Beijing in 2018, Tibet and Jiangsu in 2019, and Gansu in 2020. The temporal and spatial variations in pig epidemics and risks were mainly the result of many reasons, such as the scale of pig breeding, transportation and circulation, epidemic prevention and control capacity in different provinces, and so on.Based on the above research findings, the following countermeasures are proposed for reference. First, sound monitoring and early warning systems for pig epidemic risk are needed. For domestic and foreign pig and other animal diseases, it is necessary to establish a risk monitoring and early warning system that covers the whole industry chain, including breeding, slaughtering, processing, circulation and sales, so that timely detection, timely reporting, and timely formation and release of epidemic prevention and control early warning plans can provide a reference for scientific decision making for the pig industry and market participants.Second, the pig epidemic prevention and control system should be improved to include innovations in vaccination and culling, biosecurity and other means of disease prevention and control and should strive for an effective combination of multiple programs and efficient prevention and control. Epidemic detection in the pig industry chain of breeding, transportation, slaughtering and processing should be strengthened. The feeding management system, such as closed feeding and all-in-all-out, should be implemented; the cleaning and disinfection facilities and equipment for epidemic prevention in pig farms should be improved; farm records should be established; and pig identification, such as ear tags with activity, temperature and sound sensors, should be strictly enforced. The strategic planning of animal disease prevention and control science and technology should be strengthened; the promotion of scientific and technological innovation, transformation of results and integrated demonstrations should be accelerated; and research and development of vaccines for African swine fever and other major diseases should be accelerated. The construction of a grassroots animal disease prevention and control system, an epidemic prevention team, and grassroots epidemic prevention capacity should also be strengthened and improved. The culling subsidy system should be improved, and the enthusiasm and initiative of farm households for prevention and control should be fully mobilized.Third, the regional collaboration mechanism for epidemic prevention and control should be strengthened. To jointly build a solid “defense system” for the high-quality development of the pig industry, it is necessary to establish an overall responsibility-sharing mechanism for the prevention and control of swine diseases in production and marketing areas based on the “national chessboard”; to streamline and consolidate the responsibilities and obligations of various areas; to implement zonal prevention and control and regionally differentiated prevention and control strategies; to compensate for shortcomings and weaknesses according to local conditions; and to strengthen regional cooperation in the prevention and control of the entire industrial chain of pig and product production, transportation and slaughtering.


Nature Biotechnology 10.1038/s41587-019-0360-3, published online 5 February 2020.Correction to: In the published version of this paper, the members of the Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium were listed in the Supplementary Information; however, these members should have been included in the main paper. The original Article has been corrected to include the members and affiliations of the PCAWG Consortium in the main paper; the corrections have been made to the HTML version of the Article but not the PDF version. Additional minor corrections to affiliations have been made to the PDF and HTML versions of the original Article for consistency of information between the PCAWG list and the main paper, and in the PCAWG Technical Working Group, the two affiliations for Miguel Vazquez have been changed from Massachusetts General Hospital, Boston, MA, USA and Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain to Barcelona Supercomputing Center, Barcelona, Spain and Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.


Since the appearance of the first civilizations, various substances have been used to improve human health. Although nature is undoubtedly the source of many medicinal substances, since the early 19th century there has been an enormous development of pharmaceutical products aimed at treating or improving human health. Over time, the emergence of new generations of therapeutic agents has been observed, including not only small molecules, but also proteins and peptides, monoclonal antibodies, nucleic acids, and living cells. This progress has opened up new possibilities for the use of these therapeutic agents in the treatment of specific diseases, while at the same time causing enormous challenges in delivering them into the body while maintaining their therapeutic usefulness. For the effective action of these agents, it is necessary, among other things, for them to have proper solubility, stability, target location, off-target non-toxicity, controlled pharmacokinetics, possibility of bypassing biological barriers  or, in the case of cells, maintaining cell viability and phenotypes ,3.Polymers, along with metals and ceramics, constitute the most common platform used for DDSs ,5. They Over the past 70 years, DDS polymer materials and their designs have progressed from external devices and simple off-the-shelf macroscopic supplies through to microscopic particles and ultimately to complex and rationally designed nanocarriers. The application of DDSs has improved the clinical usefulness of many drugs and enabled new therapeutics, such as anti-cancer and siRNA therapies. However, there are still remaining challenges that drug delivery systems have to overcome to be clinically viable. The next generation of DDSs will need to be able to overcome the biological barriers which limit the delivery of complex therapeutic molecules, and utilize less invasive systems which secrete biomolecules into specific tissues, at specific times and concentrations, sometimes for a prolonged period of time. Therefore, the innovations in the field of polymer materials will be the driving force in overcoming existing boundaries, while the polymer DDSs will still be considered the most active field of biomedical research in pharmaceutical industries and academic laboratories.Polymers Special Issue dedicated to the memory of late Professor Andrzej Dworak https://www.mdpi.com/journal/polymers/special_issues/polym_carr_deliv_biomed_appli_mem_prof_Dworak (accessed on 23 February 2021)This book comprises articles concerning recent advances in natural and synthetic polymeric materials with the desired physical, chemical, biological, and biomechanical properties to match the various requirements of controlled delivery of various therapeutic agents. The book contains reviews and original articles of eminent scientists and friends of Professor Dworak, each of which was published previously as original contributions to the Prof. Dworak was an outstanding specialist with experience in the studies of the mechanisms of oxirane and cyclic imines polymerization and controlled radical polymerization of various types of monomers in order to obtain macromolecules with carefully planned structures and properties, including polymers sensitive to stimuli. In his research, he successfully translated knowledge in the field of polymer chemistry and polymer materials into their potential use in medicine and pharmacy. Prof. Dworak initiated many national and European projects in which he carried out studies in the field of basic research, including the preparation and therapeutic use of various types of nanoparticles and polymer nanocontainers carrying different types of active substances. He also managed projects related to the development of polymer supports for the culture and transfer of cell sheets, which significantly accelerated the healing process of burn wounds. The results of Prof. Dworak’s research has been published in nearly 150 articles in international journals, and he was the co-author of several patents.On 17 March 2022, the Silesian Meeting on Polymer Materials Conference (Polymat 2022) was organized and dedicated to the memory of Prof. Andrzej Dworak . The conAccording to the conference program, Prof. Axel Müller , JohannePolymers, published by the Multidisciplinary Digital Publishing Institute. In the category of advanced synthesis and study of polymeric materials, Aneta Medaj, Jagiellonian University, Cracow, Poland, was awarded for her presentation entitled “Polymer nanocapsules templated on liquid cores as model photoreactors”. In the category of interdisciplinary and international studies, Erik Dimitrov of the Institute of Polymers, Bulgarian Academy of Sciences, Sofia, Sofia University, and the Centre of Polymer and Carbon Materials, Zabrze, Poland, was awarded for the presentation “Nucleolipid vesicles. Supramolecular structures resembling spherical nucleic acids”. In the category of advanced biopolymer materials, Mattia Parati . The posters were available also on the Internet. Many of them were of high practical importance. The posters were evaluated by a special jury . The three best communications were selected and awarded prizes of EUR 450 each, funded by the Swiss journal a Parati , UniversPolymers, MDPI, and the Chemical Industry.The conference was held under the auspices of the European Federation of Polymers, the Committee of Chemistry of the Polish Academy of Sciences, and the Polish Chemical Society. The media patronage over the conference was taken by The conference was accompanied with a small exhibition of research instruments . The Scientific Committee, headed by Prof. Zbigniew Florjańczyk, was responsible for the high scientific level of the presented papers, and the Organizing Committee, headed by Prof. Alicja Utrata-Wesołek, orchestrated the smooth running of the event. The conference was attended by about 170 scientists from Poland and abroad. After the closing remarks given by Prof. Barbara Trzebicka, chairwoman of the Conference, the participants proposed a farewell toast: to meet again at Zabrze in the near future! An extended report on the conference was also published in Polish .


This article explores the first fifty years of the History of Medicine and Health Care Program in Calgary and considers the impact of interdisciplinary cooperation as well as the role of interprofessional undergraduate and clinical medical education. Through this exploration, I argue that medical history should be a central part of study curricula, that a historical understanding can provide a robust background for physicians in a fast-changing world in the clinic, and that through their disciplinary expertise, medical historians play a fruitful role in scholarly and teaching exchanges with medical students and clinicians in the modern medical humanities.Medical historians and educators have long lamented that the integration of the study of the history of medicine into the educational curricula of medical schools and clinic-based teaching has been protractedly troubled. Employing the development of the history of medicine program at the University of Calgary as a case study, this article emphasizes the importance of integrating medical history with teaching schedules to further students’ insights into changing health care settings, the social contingency of disease concepts, and socio-economic dependences of medical decision-making. History of medicine programs can furnish plentiful opportunities for research training through summer projects, insight courses, and field  Karl Sudhoff’s (1853–1938) institute for the history of medicine, which opened in 1906 at the University of Leipzig in Germany, has long been considered a gold standard for history of medicine programs affiliated with medical faculties.A statue of Hippocrates stands in the Health Sciences Centre (HSC) of the University of Calgary’s (UofC’s) Cumming School of Medicine (CSM). It is a legacy of Peter J. E.Cruse’s (1927–2006) history of medicine courses and was a gift from the sizeable Greek-Canadian population to the UofC’s new medical school.Founding faculty member Dr. Cruse pushed for the inclusion of medical history in the schedule of Calgary’s new medical school (1970–1971), from which workshops emerged for residents in surgery and staff surgeons.The Calgary Associate Clinic’s Historical Bulletin. The Bulletin, as it was previously called, was published between 1936 and 1958, focusing greatly on the history of medicine in Alberta, but also on the history of medicine in general, in 22 volumes comprising 88 issues.Canadian Bulletin of Medical History (CBMH) when it was created as the newsletter of the Canadian Society for the History of Medicine in 1979. Published twice a year for the Canadian Society for the History of Medicine, originally by Wilfrid Laurier University Press and now through the University of Toronto Press, the CBMH has prominently featured several research articles from faculty and trainees participating in Calgary’s HOMHCP.Calgary’s founding physician-historian Cruse was born in Stellenbosch, South Africa. His father, Henri P. Cruse (1894–1950) was a university professor specializing in the history of pedagogy at Stellenbosch University, while his mother Aletta (1897–1965?) worked as a schoolteacher.aficionado Bill Whitelaw, who headed the conference until 2007 , where they gave short history of medicine presentations to the assembly.2007 see .23Cambridge Scholars Publishing in Britain has emerged to document the conference proceedings and include the best peer-reviewed research papers given at the conferences. These publications combine the submitted and accepted papers regarding clinical medical history topics, as well as those topics in health care history by other interested undergraduate and graduate students from across Canada. It is also a welcome opportunity for medical residents to write and publish some of the first papers in their clinical careers. Of all the submitted conference papers, up to fifteen of the best papers are considered for publication in the conference proceedings, often making substantive contributions to our medical understanding and the existing historiography, including for example original work on the early ambulatory and mobile clinical stations in Atlantic Canada, the introduction of super glue into modern surgery, and assessments of the economy of material culture of menstruation products in public health and gynaecology to mention here only a few.Presentation topics at the HMDs have covered areas such as the classics , history of public health , nursing (including the interdisciplinary nature of modern medicine and the physician-nurse relationship), veterinary medicine , as well as neuroscience  see . Prizes,The review process and the selection of high-quality papers is made by a local committee, which receives further input from the board of advisors, as well as from external historians of medicine. These selection processes have engendered a significant academic appeal for the HMDs at the UofC.Medical school instructors have long pondered the challenges of incorporating history of medicine teaching in student and clinical education, seeking ways to furbish insights into the humanities, social contextualization, and create ethical awareness in the curricula.(1) To attract students and faculty from interdisciplinary backgrounds and cross-departmental affiliation to engage in and contribute to the Program’s activities…; (2) to develop and expand the profile and standing of the Program within medical and interdisciplinary communities engaging in historical research and teaching medicine and health care across Canada and abroad; (3) to relate to the university, the local community and the public at large explaining and interpreting topics from the history of medicine, the life sciences and neuroscience…; (4) to conduct interdisciplinary teaching and research in the CSM and beyond by integrating views from the History and Philosophy of Science, Science and Technology Studies, Cultural and Media Studies.This directional statement emphasizes the importance of engaging with the social, cultural, political, and economic contexts of clinical training and medical knowledge. Today, the half-time validity of medical knowledge is getting increasingly shorter and 50% of medicine’s knowledge basis is revised every 5 years.Building a wider understanding of the central task and function of history in current medical curricula remains attractive to students, since it provides a valuable foundation to them.practica offered, which make extensive use of the Dr. Cruse Collection and Mackie Collection for their research projects and presentations concerning medical history.Furthermore, a significant number of the history of medicine books from the former Calgary Associate Clinic were later donated to the UofC’s Health Sciences Library. There, the collection was merged with the “Dr. Peter J. Cruse Collection” and the “Mackie Family Collection in the History of Neuroscience.”Enticing collaborations in research and education among physicians, medical scientists, historians, sociologists, and anthropologists has been, and continues to be, a foundational motivation for the UofC HOMHCP. To this end, meeting and exchange platforms, the history of medicine library collection, as well as interest groups and specialized colloquia, have been established to foster the interaction between the humanities and health sciences. Since 2012, the mutual interaction in the wider field of the medical humanities has also become institutionalized through the collaboration with other members of the CSM’s Health Care Humanities Committee.In their previous article “Making the Case for History in Medical Education” in this journal, David S. Jones et al. have argued that they see both chances as well as challenges with integrating medical history within the medical humanities, while making “the case for history as an essential component of medical knowledge, reasoning, and practice.”clientèle as the Monday lectures, offer practical instruction and experience on various topics, ranging from skills for public presentation, academic discussion, history research methodology, to history of medical techniques with some hands-on experiential learning. The course offers thereby a good chance for medical students to establish informal relationships with faculty, who later serve as faculty preceptors in students’ disciplines of interest for individual research projects and even as collaborators on mutual publications.The history of medicine courses are comprised of a series of lectures and seminars held on Mondays from 12:30 to 1:20 PM throughout the full academic year, which highlight particular themes, episodes, controversies, people, and events in the history of medicine. The types of history taught in these courses include the social history of medicine, the history of medical ideas, laboratory history, the relationship of the history of medicine with the history of science and the Science and Technology Studies (STS), elements from public health history, as well as the relationship between the history of medical technologies and modern media studies. These lectures and seminars, attended by medical students, residents, postdocs, and interested clinical faculty, provide an overview of history of medicine and are taught by both historians and medical faculty actively publishing in the history of pathology, pediatrics, geriatrics, public health, as well as complementary and alternative medicine.curriculum vitae as well as their electronic Canadian Resident Matching Service portfolios.Proceedings of the Annual History of Medicine Days.At the end of each academic year, the associate dean for undergraduate medical education receives a letter about each student’s participation in the course and spin-off activities, including archival work, presentations, and publications, as these are always seen as valuable additions to a student’s This content of the UofC’s HOMHCP is hence fully aligned with most of the strategies for history at medical schools in the US and Canada as pointed out in “Making the Case for History in Medical Education.” The concerns articulated in their article regarding resource competition between the medical humanities and history of medicine would not necessarily lead to antagonism but can also be overcome through mutual forms of collaboration and the emphasis of interdisciplinary strengths. Furthermore, Jones et al.’s focus on reframing history of medicine as a field that is based in science studies and history of science, discussing questions of paradigms, biopolitics, discourses, and postmodernism, can also be widened to include valuable public health perspectives, areas of comparative and global history, along with important aspects of intersectionality and indigeneity regarding the history of medicine and health care.Students could also submit abstracts on medical topics to the Royal College of Family Physicians of Canada for their student prize competition.aperçu: “art always outlasts science.”Although the Calgary History of Medicine and Health Care course has changed in nature and scope since it was started by Peter Cruse, students remain committed to the experience of the program, which offers them insight from various faculty members into their specific areas of interest.Clio in the Clinic emphasizes. The current analysis of the local history of medicine program can offer useful insights into the proliferation of the program along with the available resources and history of medicine collections. Education studies have frequently examined history of medicine programs to elicit how medicine is perceived, understood, and taught with a critical perspective to its historical development and socio-cultural context. This article has examined the historical steps that led to the foundation of the UofC’s HOMHCP and its context in the reform education initiatives at this younger medical school in Canada. The support of external funding agencies, the AMF and the Hannah Foundation (now the AMS), was instrumental in bringing a medical history perspective into the educational setting in Calgary. Rather being wedded to contingent local settings, the UofC has tried to reach out to other medical schools, nursing schools, and history of medicine programs, to stimulate active exchanges and place history of medicine in a wider communicative network.Comparatively few North American medical schools include medical historians and history of medicine courses. At the UofC’s CSM, the muse of history is nevertheless seen as integrative to medical teaching, research, and collaboration, as this case study submitted to Further networking opportunities were woven into the fabric of many of the history of medicine courses, including exchanges with colleagues from clinical education, and interdisciplinary collaboration with other historians, philosophers, anthropologists, and ethicists, as well as inter-professional panels.This collaborative community is locally supported by the planning committees, the award committees, and a pool of volunteering judges and conference moderators. The program is presently supported by Melanie Stapleton, a gastroenterologist as first co-chair and Lesley Bolton, a classicist, as second co-chair; Stephen Pow, who arrived from the Central European University, Budapest, Hungary, as an AMS-funded postdoc; sessional history instructor Susan McMahon as a research associate; and Marcia Garcia as the course and conference coordinator; along with physician-historian Robert Lampard holding an adjunct position in the department of community health sciences. Previous postdocs have included Fedir Razumenko from Saskatoon, Saskatchewan; Aleksandra Loewenau from Oxford, UK; Will Pratt from Edmonton, Canada; and Matt Oram from Christchurch, New Zealand. The program is administratively located in the CSM and can be found on the third floor of the Cal Wenzel Precision Health Building, while the Science, Technology, Environment, and Medicine Studies laboratory is housed on the eighth floor of the Faculty of Arts, and the History of Medicine Room in the library being located on the first floor of the HSC. The following individuals or administrators serve on the advisory committee: the chair is the associate dean, research (CSM), Bill Whitelaw as former HOMHCP chair, the head of the department of community health sciences, the head of the department of history, the associate dean for undergraduate medical education (CSM), the director of the O’Brien Institute for Public Health, the director of the Hotchkiss Brain Institute, classicist Peter Toohey, the dean of the Faculty of Arts, a student representative, and the CEO of AMS. The current state of the history of medicine curriculum at the UofC has further been exported to other schools, most visibly at the UofA’s medical school in Edmonton, where the history of medicine interest program was restarted and revitalized by Jamil Kassam, a historian trained at the University of Chicago with see  a speciaReviewing the structure and function of the HOMHCP reveals similarities, differences, and cooperation features with other history of medicine programs that developed around the same time across Canada. Many students and trainees from these centres have attended the HMDs conferences in Calgary:Its program in the medical humanities is located in the faculty of medicine and was led for four decades by physician-historian Jock Murray, who had been the former dean of the faculty. The program is primarily addressed to undergraduate medical students. Staff members include medical humanities scholar Wendy Stewart, historian of medicine Ronald Stewart, Marc Gilbert as postdoc, and Ana Sardinha as administrator.The department of social studies of medicine was founded in 1966 by Donald G. Bates (1933–2001). It is situated in the medical faculty, but members are cross-appointed in the departments of their home discipline. A lecture on the history of medicine and seminar-style block courses are taught in the medical faculty, yet most of the undergraduate teaching occurs within the disciplinary departments. McGill’s is a research-intensive department, staffed by architectural historian Annmarie Adams as chair, sociologist of science Alberto Cambrosio, bioethicist Jennifer Fishman, medical ethicist Phoebe Friesen, bioethicist Jonathan Kimmelman, medical ethicist Nicholas King, historian of medicine Thomas Schlich, anthropologist Margaret Lock, medical historian Andrea Tone, medievalist Faith Wallis, historian of medicine George Weisz, and anthropologist Todd Meyers.The Institute for the History and Philosophy of Science and Technology was created in 1967 as a graduate studies and research institute. As an autonomous unit, it remains outside the medical faculty, with close relations to other UofT faculties. Academic staff include philosopher of science Brian Baigrie, philosopher of science Hakob Barseghyan, philosopher of science Joseph Berkovitz, historian of medicine Lucia Dacome, religious studies scholar Yiftach Fehige, historian of mathematics Craig Fraser, historian of biology Nikolai Kremensov, philosopher of sociology Mark Solovey, medical anthropologist Wen-Ching Sung, historian of biology Marga Vicedo, philosopher of biology Denis Walsh, historian of technology Rebecca Woods, and historian of physics Chen-Pang Yeang.Furthermore, the other seven Hannah Chairs continue to send students and participate themselves regularly in the HMDs, as organized by the UofC’s own Hannah Chair.A particular aim of many history of medicine programs is the reinterpretation of Western culture, medicine, and science in critical, epistemological, constructivist, and other perspectives through teaching and research in medicine.[The Introduction of the teaching of history of medicine] is unlikely to occur in a “top-down” fashion…, it is much more likely to occur in a “ground-up” fashion, whereby energetic, committed, politically adroit historians will take advantage of local circumstances and opportunities at their own institutions, succeed in their work, and thereby facilitate the growth and spread of the effort.History of medicine programs actively further interdisciplinary collaboration between departments, faculties, and beyond – and, what is perhaps one of the greatest benefits of all, teaching faculty are available to meet with individual students to discuss their interests, provide feedback on history of medicine and career path questions, and offer research preceptorships for projects. Most medical schools, with their rather large budgets, could afford to finance medical history positions and would derive significant profit from them. The study of the history of medicine is central to the training of future doctors – from day one of their classes, while offering a space for insightful reflection of their work on the clinical wards and clerkship periods – through the medical humanities and within the (ever) ongoing reform activities in medical education.


Geopolymer (GP) is environmentally friendly, has good mechanical properties and long-term workability, and has broad application prospects. However, due to the poor tensile strength and toughness of GPs, they are sensitive to microcracks, which limits their application in engineering. Fiber can be added to GPs to limit the growth of cracks and enhance the toughness of the GP. Plant fiber (PF) is cheap, easy to obtain, and abundant in source, which can be added to GP to improve the properties of composites. This paper reviews recent studies on the early properties of plant fiber-reinforced geopolymers (PFRGs). In this manuscript, the properties of PFs commonly used for GP reinforcements are summarized. The early properties of PFRGs were reviewed, including the rheological properties of fresh GPs, the early strength of PFRGs, and the early shrinkage and deformation properties of PFRGs. At the same time, the action mechanism and influencing factors of PFRGs are also introduced. Based on the comprehensive analysis of the early properties of PFRGs, the adverse effects of PFs on the early properties of GPs and the solutions were summarized. At present, Geopolymers (GPs) are considered an environmentally friendly alternative to traditional building materials and an ecological material to replace traditional cement in recent years ,2,3. ComIn general, the synthesis of GPs consists of an active solid silicaluminate precursor and activator solution. The source of precursor material is very rich. For example, kaolin, silica fume, fly ash, slag, and other industrial wastes . The mos4 and Al-O4 tetrahedral units. GPs are an environmentally friendly cementing material with low energy consumption and less pollutant emission in the production process [As mentioned earlier, GPs are an emerging sustainable material that meets the goals of energy conservation and environmental protection and can reduce carbon dioxide emissions in the environment. GPs are inorganic polymer materials with a three-dimensional network structure composed of Si-O process ,10. Howe process ,12. Fibe process . Because process ,15.Plant fiber (PF) has the advantages of low density and a high length-diameter ratio. It is not only cheap and readily available, but also comes from abundant sources and can be repeatedly processed and biodegradable . At the In recent years, PFs have been gradually applied to the development of engineering materials to improve the brittleness and other properties of cementing materials ,19,20. AResearch in recent decades shows that PF is feasible to replace synthetic fiber in GP composites. The research on the early properties of plant fiber-reinforced geopolymers (PFRGs) in recent years is reviewed. In this paper, the characteristics of PFs commonly used in GPs and the properties of fiber-reinforced geopolymers are briefly reviewed. The research on the early properties of PFRGs is discussed, including the rheological properties of freshly mixed slurry, early strength of GPs, early shrinkage deformation and cracking of GPs, etc. The action mechanism and influencing factors of early properties of GPs were introduced. The microstructure of GP in the early reaction process was analyzed and discussed.PFs are abundant, widely distributed, and have many other advantages. They are not only low-cost but also have good mechanical properties and are biodegradable ,28. The As can be seen in However, compared with other types of fibers, PFs have unique properties that enable them to bond effectively to the substrate. 6H10O5)n. The chemical structure of the GPs is shown in Cement produces gels due to the hydration of mineral particles, but the reaction systems of GPs and cement-based materials are quite different. Cellulose is the most important component of PFs, and its chemical formula is (CSome researchers believe that the reaction process of GP mainly consists of dissolution, diffusion, polymerization, and solidification. First, when aluminum silicate raw materials are dissolved in an alkali activator solution, many silicon and aluminum monomers can be produced. The silicon and aluminum monomers gradually diffused from the surface to the inside and then condensed rapidly to form the oligomer gel phase of silicon and aluminum. Finally, the silica-alumina oligomer gel phase solidifies and hardens into GP concrete ,77. HoweWhen PF is added to the GP matrix, a series of changes will occur in fiber properties. The compatibility between PFs and GP matrix will affect the workabilities and mechanical properties of composites to a great extent. Tan et al.  studied The PF itself has an internal cavity structure ,30,31. B−3. Pimraksa et al. [Fiber can affect the density of composites as well as the water absorption. Liu et al.  studied a et al.  believeda et al.  studied a et al.  added siThe interface characteristics and adhesion of fibers and matrix are key factors in the interface control technology of composites ,80. The In fact, by adding kaolin and nanoclay, the porosity and pore size distribution of cement mortar is reduced ,93. On tGP is considered a green alternative to Portland cement. Previous studies on GPs have focused on their chemical and mechanical properties, microstructure, and potential applications, but few researchers have focused on their rheological behavior. In the fresh state, good workability of PFRGs is a prerequisite for better mechanical properties ,95. The Slump value is one of the important characteristics of the workability of fresh concrete. Slump tests can judge the workability and the freshness of the mixture. Compared with other fibers, steel fiber, and other conventional fibers are considered to be one the potential reinforcement fibers in GP composites. These fibers can enhance the flexural strength, tensile strength, ductility, and toughness of GP composites ,100. HowBashar et al.  conducteIn contrast to traditional inorganic fibers, the sugar in PF is easy to hydrolyze under the action of alkalinity in the matrix. Hydrolysate plays an anticoagulant role in the hardening of the composite. At the same time, the fluidity of the slurry will be significantly reduced, and the slump loss of the slurry will be accelerated.Wongsa et al.  found thAbbas et al.  studied Similar to the above studies, Su et al.  studied In summary, the workability loss of different types of fiber-reinforced GP mixtures is affected by their type, aspect ratio, and content in the mixture. The workability reduction of PF is higher than that of steel fiber and inorganic fiber with the same GP matrix. This is due to the high water absorption of PFs. Therefore, pre-wetting or pretreatment of PFs before the addition of GP mixtures can reduce the absorbent chemical composition of the fibers.From the perspective of low carbon and environmental protection, relevant personnel also carried out research on the related properties of waste PFRGs . Liu et Malkawi et al.  used palIn addition, the effect of setting time is also an important index to evaluate the rheological properties of GPs. Ferreira  et al. i2 and C-S-H will be produced in the hydration process of cement, which will increase the viscosity of the system and thus increase the slump loss of concrete. Adding admixtures to concrete is beneficial to maintaining the good fluidity of concrete. The surface of mineral admixtures is smooth and dense. When mixing concrete, they are dispersed among cement particles, and these dense particles act as dispersants.Many factors affect the rheological properties of GPs. Due to the high viscosity of sodium silicate solution, the rheology of GPs is quite different from that of ordinary concrete . When ceThe higher ratio of sodium silicate to sodium hydroxide in the GPs exacerbates the viscosity effect and further reduces the slurry flow ,119. SimIn addition, increasing the volume of the activator solution has been shown to improve rheology without significantly affecting the compressive strength of the mixture due to an increase in its liquid-solid ratio . Su et aThe addition of PFs will reduce the fluidity of the GP slurry and shorten the setting time of the slurry. The addition of some materials, such as rice husk ash, also affects the rheological properties of the GPs. Das et al. found that due to the absorption characteristics of rice husk ash particles, rice husk ash has a high water requirement, and insufficient water content will lead to faster hardening, thus reducing the processing capacity and setting time ,122.PFs affect the early strength of GPs, including compressive strength, flexural strength, and tensile strength. The results show that the PF can shorten the setting time of the matrix and improve the ductility and tensile strength of composites. Its influence on the composites is mainly manifested in the enhancement of toughness and the decrease of compressive strength ,124.The early strength of GPs is higher than that of cement concrete. Saranya et al.  found th2 to 21.25 N/mm2 when 0.5% coir fiber was added. Korniejenko et al. [Both traditional inorganic fiber and PF can affect the compressive strength of the GP matrix. Korniejenko et al.  analyzedo et al.  analyzedExcessive fiber addition and uneven distribution in the matrix have adverse effects on the compressive strength of GPs . LazorenAbbas et al.  studied The effect of waste fibers such as straw on the compressive strength of the GP matrix is similar to that of sisal and coir fibers. Workiye et al.  preparedThe mechanical properties of PFs can improve the flexural strength of GPs, which is due to the high tensile strength and elastic modulus of PFs. The tensile stress exerted on the composite matrix can be transferred to the fiber through the interfacial bonding between the fiber and the GP matrix. In GP composites, fiber types, and properties are more effective than matrix properties in improving fracture properties such as flexural strength. Fiber properties control the failure mechanism and fracture characteristics of composites.Lazorenko et al.  showed tThe flexural behavior of PFRGs is similar to the compressive behavior. Zhou et al.  studied Abbas et al.  investigKorniejenko et al.  found thSimilar to flax fiber, cotton fiber, sisal fiber, and coir fiber, related studies found that sawdust produced consistent results in the GP matrix . SawdustAs can be seen from Through microscopic analysis of the early reaction process of GPs, researchers have further understood the structure and formation mechanism of the early reaction of PFRGs, to better understand their early properties. With the further study and development of the chemical reaction and mechanism of GPs, other early characterization techniques have been gradually developed and applied.Wongsa et al.  conducteFrydrych et al.  showed bIn contrast to cement-based materials, water does not participate in hydration during polymerization. In this process, the purpose of adding water is to provide a workable mixture. Over time, this excess water will dissipate and cause significant shrinkage of the GPs . ShrinkaPF can reduce the shrinkage of the matrix . Some stAlthough the mechanical properties of GPs containing PFs have been studied extensively, the effects of these fibers on the drying and shrinkage properties have been significantly less reported. Su et al.  observedFibers can act as bridges in cement-based materials to prevent the spread of cracks. The morphology of the fibers has a great influence on their bonding properties with the cementitious matrix. The main function of fiber is not to improve the compressive strength of composites but to improve its toughness and control the further development of matrix cracks.Alomayri et al.  found thGPs are cost-effective, environmentally friendly, and consume relatively little energy. However, the early tensile strength of GPs is relatively poor, and the mechanical properties of GPs can be improved by adding PFs.There are many studies on the mechanical properties of PFRGs, including the durability and degradation of PFs in a matrix. In recent years, more and more types of fibers have been used as reinforcements in a GP matrix. The recent advances of PFRGs are mainly reflected in the following aspects:Various recycled reinforcements have been used to prepare PFRGs, such as wastepaper sludge, waste cotton stalk, bagasse, and straw particles;Due to the need for intelligent construction technology, good early performance of PFRGs, including flowability and buildability, is becoming increasingly important, such as the development and preparation of 3d printing PFRGs;As the admixture of composites, nanomaterials are added to the PFRGs to improve the physical and mechanical properties of the matrix, such as nanoclay and nanocellulose;A variety of PFs pretreatment methods are used to improve the characteristics of PFs, to enhance the performance of PFRGs.The early properties of PFRGs are studied, including the rheological properties of freshly mixed GP slurry, the early compressive strength and flexural strength of GP, and the early shrinkage deformation and cracking of GP.The addition of PFs greatly delays the setting time of cement-based composites. However, unlike cement, the addition of PFs shortens the setting time of GP due to the heat that may be generated during the degradation of PFs.The degree of workability loss of different types of fiber-reinforced GP mixtures is affected by fiber type, aspect ratio, and content in the mixture.PF can improve the early flexural strength of composites and has the function of toughening and strengthening composites. The higher the content of cellulose, the greater the toughening and strengthening function.Compared with traditional fibers, the influence of PFs on the early performance of GPs mainly has the following problems:In an alkaline environment, cellulose, hemicellulose, and lignin of PFs are easily hydrolyzed to produce carbohydrate substances. However, saccharides can hinder the solidification of GPs and inhibit the strength development and setting time of cementitious materials during the polymerization, which will have a negative effect on the early mechanical properties of GPs. The characteristics of PF cause its water absorption, variability, and cementitious material bonding to be poor. Because of the high water absorption, the effect of PF on the workability of the GP matrix is higher than that of steel fiber and inorganic fiber.Through this study, the application of PFs to GPs as reinforcing materials has an adverse effect on the early performance of composites, mainly on the fluidity of mixtures. To solve these problems, PFs can be pretreated with chemical modification to solve them.


Department of Respiratory, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.In the published article, there was an error regarding the affiliation for Shicong Zhu. Instead of having affiliation 1, they should have The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.


Formerly Scientific Officer, Medical Research Council Social and Community Psychiatric Unit, Institute of Psychiatry, London, UKJohn Birtchnell, who died on 5 September 2022 at the age of 90, had a long and prolific career in psychiatric research. A common factor linking his areas of research interest was the definition and measurement of psychological dependence. It was out of this that he developed his general theory of relating, which he regarded as his most important contribution to knowledge.Throughout his career John balanced his pursuit of statistically valid data from populations with the in-depth knowledge of individuals, couples and families gained through his clinical work as a psychotherapist. In over 100 published papers, topics included early loss and separation experiences, social class and mental illness, marital quality and depression, the causes and management of attempted suicide and maladaptive forms of relating. In later years John drew on evolutionary theory to theorise on brain function and was fascinated by aspects of memory even as his own was failing.John was born in Aylesbury on 8 April 1932, the only child of Wilfred and Minnie Birtchnell. His father was an aircraft fitter. The family moved to Gloucester when he was five, his father taking a job in a nearby aircraft factory. John attended Sir Thomas Rich School. His schooling was interrupted when, at the age of 12, he fell from a tree, sustaining a compound fracture of his arm and nearly dying of septicaemia, being saved by the recent introduction of sulphonamides. A second medical emergency was the outcome of his quest for knowledge, when, at the age of 15, learning that six berries of deadly nightshade would be lethal, he thought it would be interesting to experience the effects of three.Already confirmed in his wish to be a psychiatrist before he studied medicine at Edinburgh University, he did house jobs in psychiatry and neurosurgery, then senior house officer posts in Liverpool in neurology and psychiatry, obtaining the Diploma in Psychological Medicine in 1963. After clinical posts at Crichton Royal Hospital (Dumfries) and St John's Hospital (Aylesbury) he went to Aberdeen. His earliest research interests were in the possible short- and long-term consequences of parental death, the topic of his MD thesis, at Aberdeen University, where he subsequently trained full time in psychotherapy, obtaining the Aberdeen University Diploma in Psychotherapy.For the remainder of his career he worked for the Medical Research Council, commencing as an MRC Clinical Research Fellow in the Department of Mental Health, Aberdeen University, where he worked on the Aberdeen Case Register, then moving in 1970 to the MRC Clinical Psychiatry Unit at Graylingwell Hospital, Chichester, under the directorship of Dr Peter Sainsbury. Here the focus was research on suicide and attempted suicide. On Dr Sainsbury's retirement in 1982, this unit was disbanded and John was relocated to the MRC Social Psychiatry Unit at the Institute of Psychiatry, London, where he worked for most of his career. After his retirement in 1998, he continued to work as an Attached Worker with the Section of Clinical Psychiatry at the Institute.British Journal of Medical Psychology (1989–1995) and it is a measure of his ability to work collaboratively across disciplines that, as well as being a Fellow of the Royal College of Psychiatrists, he was awarded the Fellowship of the British Psychological Society and Honorary Membership of the British Association of Art Therapists.He was the editor of the A young man preoccupied with his nose. He wrote papers on art therapy and contributed over a 20-year period to an annual residential art therapy school at Leeds Metropolitan University.John was a keen amateur artist and developed an interest in art therapy while at Aberdeen. It was there that he made a film He married Rosemary (Niven) in 1961 and they divorced in 1969. He met his second wife, Sandra, in 1970, when she came on secondment to the MRC Unit in Chichester, the courtship ritual including writing two papers together. Following marriage in 1973, they had two sons. In later years, he developed Alzheimer's disease which had a chronic course. His illness spared him the grief of the loss of his younger son in 2020. He is survived by his wife, elder son and grandson.