184 Effects of The Coronavirus Pandemic on Medical and Surgical Education: Results of An International Survey by The International Association of Student Surgical Societies (IASSS)

Aim Coronavirus disease 2019 (COVID-19) presents a variety of unforeseen challenges to medical students and surgical trainees. Adaptations to the content and delivery of medical education are inevitable as institutions respond to the virus. Departments face significant restructuring, with important implications for training. Our aim was to assess the global impact of the first wave of COVID-19 on medical and surgical education. Method Between 12 May and 26 May 2020, an online survey was conducted and circulated to contacts of the International Association of Student Surgical Societies, including medical students and healthcare practitioners. All data were anonymous; no personal identifiable information was collected. Consent was implied by participation in the survey, which was on a voluntary basis. Results We collated 527 responses from 111 institutions across 26 countries. Globally, 93.5% of medical student placements were affected by the first wave of COVID-19, with examination restructuring and alternative teaching methods employed by 87.8% of medical schools. Trainee redeployment was common in both surgical (61.5%) and non-surgical (77.1%) disciplines. Surgical services were significantly affected, with reduced elective procedures in 93% of institutions. On an individual level, COVID-19 resulted in prolonged absence from clinical duties and mental health concerns at all levels of training. Conclusions Our data highlight drastic changes in medical and surgical education and practice as a result of the first wave of COVID-19. These changes are significant at all levels of training, both institutionally and individually. The pandemic is likely to have persistent consequences for future trainees in terms of education and career progression.

Return-to-Play Considerations Following a COVID-19 Infection in Elite Athletes

The COVID-19 pandemic has created a unique challenge for sports medicine staffs as they are attempting to safely transition elite athletes into sport participation after a COVID-19 infection. Athletes must isolate for a period of time after testing positive for COVID-19 to prevent the spread of the virus within a community. After an isolation period, a battery of cardiac tests must be given to assess whether or not an athlete is ready to begin a reconditioning protocol. A return-to-play plan should be established to safely re-integrate high-level athletes into strength and conditioning, sport-specific drill work, and contact drill work. Elite athletes should also be gradually eased back into full training loads in order to avoid increases in orthopedic injuries after a prolonged absence from training.

Structures of the archaerhodopsin-3 transporter reveal that disordering of internal water networks underpins receptor sensitization

Many transmembrane receptors have a desensitized state, in which they are unable to respond to external stimuli. The family of microbial rhodopsin proteins includes one such group of receptors, whose inactive or dark-adapted (DA) state is established in the prolonged absence of light. Here, we present high-resolution crystal structures of the ground (light-adapted) and DA states of Archaerhodopsin-3 (AR3), solved to 1.1 Å and 1.3 Å resolution respectively. We observe significant differences between the two states in the dynamics of water molecules that are coupled via H-bonds to the retinal Schiff Base. Supporting QM/MM calculations reveal how the DA state permits a thermodynamic equilibrium between retinal isomers to be established, and how this same change is prevented in the ground state in the absence of light. We suggest that the different arrangement of internal water networks in AR3 is responsible for the faster photocycle kinetics compared to homologs.

Masculinity, Intimacy, and Mourning: A Father’s Memoir of His Son Killed in Action in World War II

Emotional restraint was the norm for the bereaved during and after the Second World War. Displays of individual grief were discouraged, and overshadowed by a wider concern for mass bereavement. There is limited archival evidence of the suffering that fathers of sons killed in action endured. This article draws upon and analyses a powerful memoir written by my grandfather, lamenting the death of his only son killed in action near the end of the War. While most men contained their emotions in such circumstances, this extended lament expresses a range of deep feelings: Love and care for the departed son, tenderness towards other family members, guilt at sending his son away to boarding school, loss of faith in (Christian) religion, and a sense of worthlessness and personal failure. Of particular interest is the impact of geographical distance over which this narrative is played out, and what it reveals about the experience of one white British middle-class family living overseas, but strongly interconnected with ‘home’ (and specifically Scotland). It also documents the pain of prolonged absence as a result of war; often boys sent ‘home’ to board were separated from their parents for much of their childhood, and were forced to ‘become men’—but not as their parents had envisaged. The article concludes by exploring the implications of this private memoir and what it reveals about memoir, masculinity, and subjectivity; gender and grieving; connections with ‘home’; and constructing meaning after trauma.

“A wife or friend at e’ery Port”

The “sailor ballads” of the early British Empire employ popular song not only to investigate sailors’ hardships and victories, but to explore the character attributes of seafaring men. This article argues that the range of attitudes and concerns present in these texts signals a larger cultural conversation about these men’s fitness as husbands to the nation’s women, fathers to its children, and members of its communities. Although protoimperialist and mercantilist writers such as John Dee, Robert Hitchcock, and Edward Misselden stressed the social benefits of employing common men in large-scale seafaring projects, the ballads explore the consequences of the common sailor’s presence—and most particularly, his prolonged absence—on the traditional stabilizing structures of family and community. In doing so, the ballads critically examine the potential rewards and consequences of imperial expansion from a terrestrial, local, and communal perspective.

THE STRUCTURE DYNAMICS OF POST-PYROGENIC COWBERRY PINE STANDS OF THE NORTHERN CIS-URAL (KOMI REPUBLIC)

Observations results of the development of cowberry pine stands on Pechoro-Ilychsky Reserve territory using the method of permanent sample plots are presented. It was established that pine stands, despite the active replenishment of their species composition with young coniferous trees, have a relatively stable supply of stem wood. It is noted that with a prolonged absence of fires, an active replenishment of the forest stand with new generations of Pinus sylvestris, Picea obovata and Pinus sibirica trees of different ages. It revealed that grassroots weak fires contribute jump regeneration of Picea obovata and Pinus sibirica that are gradually introduced into the pine stands.

Nostalgia originii la Andreï Makine, Testamentul francez și Sorin Titel, Țara îndepărtată / The nostalgia of the place of birth in Andrei Makine's French Will and in Sorin Titel's The Aloof Country

In the Middle Ages, exile meant expatriation, the prolonged absence from the native lands, one can say that a person is in exile when it is not possible to return back home. Exile involves unsettlement; the expatriated suffers from nostalgia and tries to recover his origin, the center, his home. Thinking about the past involves an idealized representation of lived history, which may have the effect of a mythical evocation of the past. The nostalgia is one of the central ideas of the novels of the Russian writer Andreï Makine, who has hardly built his identity as a Russian writer of French, his literary beginnings being not simple. The theme of the nostalgia and the parallel between two different worlds are constantly found in Makine's novels, and in The French Will it gets a special note. Andreï Makine says in interviews that he chose to write in French, but his country of origin is always in his soul. Another writer – Romanian this time – in whose novels we find the nostalgia of origins is Sorin Titel, who reveals an unusual world, Banat, where the writer was born. The estrangement from Banat has beneficial consequences in almost all respects. Established in Bucharest, the author has the nostalgia of Banat and transforms it into an epic projection, reinvents Banat. The removal from the places of origin, the distancing, the alienation, are mandatory conditions of the pilgrimage to himself, for only by being far from Banat he could reinvent him, using the memories of his childhood. Even the title of his first book with which he begins the recuperation is enlightening: The Aloof Country, signifying both the Banat, geographically, and the age of childhood, at a symbolic level. This is the case with the two writers, Andreï Makine and Sorin Titel, writers who being far away from their native places, have fictionally translated what they feel for home - Russia and Banat.

Resolved epilepsy: an updated insight

Classification of epilepsy is of great importance at the stages of rehabilitation when the disease is considered resolved. This is the time to address various aspects of etiology, pathogenesis, compensation and resolution of epilepsy and to decide upon further medical care. Materials and methods. Here we review clinical-neurophysiological, experimentalpsychological, and neuroimaging results of anti-epileptic treatment and its discontinuation in seizure-free patients. We also discuss the adoption of the new international classification of ILAE 2017 in the domestic epileptology and analyze clinical cases of 270 patients with epilepsy who were in control of seizures for up to 8 years. Results. The study revealed the clinical, neuropsychological and neurophysiological signs of epilepsy regression in patients with long-term control of seizures. In 85% of these patients, seizures were under control; in 45% of them, the issue of “resolution of epilepsy” was a matter of discussion. In this regard, we address the timing and indications for the discontinuation of antiepileptic drugs. Conclusion. The prolonged absence of seizures is due to an inhibition of epileptic activity at the neuronal level with a gradual restoration of the antiepileptic system during 3-5 years of seizure-free period; this mechanism is reflected in the new classification. The data obtained in the present study support the decision of the Russian League against Epilepsy to introduce the new classification of epilepsy proposed by ILAE in 2017. The new term “resolved epilepsy” has been adopted for use in patients previously referred to as “practically recovered”.

Gabonese government reassurances will ring hollow

Significance The president’s health troubles and prolonged absence have created a political crisis and fears of institutional instability. With the economy struggling amid declining oil revenues, the Bongo family’s political power is fragile. Impacts Ongoing unease surrounding Bongo’s presidency may undermine interest in a planned new oil licensing round. Despite opposition uncertainties, a popular uprising to oust Bongo remains a possibility over the short-to-medium term. A potential corruption scandal involving French newspaper Liberation and the Gabonese authorities could ensnare more regime insiders.