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Erin M Lowery,1 Aleah L Brubaker,2 Erica Kuhlmann,1 Elizabeth J Kovacs31Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine at Loyola University Medical Center, 2Loyola University Stritch School of Medicine, 3Department of Surgery, Loyola University Medical Center, Maywood, IL, USAAbstract: There are many age-associated changes in the respiratory and pulmonary immune system. These changes include decreases in the volume of the thoracic cavity, reduced lung volumes, and alterations in the muscles that aid respiration. Muscle function on a cellular level in the aging population is less efficient. The elderly population has less pulmonary reserve, and cough strength is decreased in the elderly population due to anatomic changes and muscle atrophy. Clearance of particles from the lung through the mucociliary elevator is decreased and associated with ciliary dysfunction. Many complex changes in immunity with aging contribute to increased susceptibility to infections including a less robust immune response from both the innate and adaptive immune systems. Considering all of these age-related changes to the lungs, pulmonary disease has significant consequences for the aging population. Chronic lower respiratory tract disease is the third leading cause of death in people aged 65 years and older. With a large and growing aging population, it is critical to understand how the body changes with age and how this impacts the entire respiratory system. Understanding the aging process in the lung is necessary in order to provide optimal care to our aging population. This review focuses on the nonpathologic aging process in the lung, including structural changes, changes in muscle function, and pulmonary immunologic function, with special consideration of obstructive lung disease in the elderly.Keywords: aging, lung, pulmonary immunology, COPD

STUDY QUESTION When couples have to face recurrent pregnancy loss (RPL), what are the partners' wishes and needs and what is their perception of helpful and unhelpful factors with regard to their own, their partners' and their families' and friends' ways of dealing with the problem? SUMMARY ANSWER Women and men with repeated miscarriages want open communication about their losses, but expect a sensitive and empathetic attitude from others, not pity or trivialization. WHAT IS KNOWN ALREADY RPL not only causes the women affected and their partners considerable emotional distress; it also has an impact on the couples' relationships and the way they relate to their families and friends. Studies suggest that women have a greater need than their male partners to talk about their losses and that these differences may lead to dissatisfaction and cause relational tension. In addition, men often assume a 'mainstay' role, supporting their partners and displaying fortitude in the face of distress. As yet, however, little research has been conducted so far on the question of what the members of couples with RPL expect from one another and from their families and friends. STUDY DESIGN, SIZE, DURATION The study sample consisted of 147 couples and 17 women with at least 2 miscarriages attending the special unit for RPL at the University Women's Hospital in Heidelberg (Germany) for the first time between September 2018 and October 2020 (response rate: 82.7%). The patients were asked to participate in this combined qualitative and questionnaire study. PARTICIPANTS/MATERIALS, SETTING, METHODS In order to explore the wishes and needs of those affected in more detail, the free text responses obtained were examined in this study by using qualitative content analysis. Categories and subcategories were created inductively to summarize and systematize content. MAIN RESULTS AND THE ROLE OF CHANCE Patients affected by RPL want their partners and their families and friends to deal with the topic openly and empathically. In the partnership itself, acceptance of individual grieving modes and sharing a common goal are important factors. Men, in particular, want their partners to be optimistic in facing up to the situation. Regarding communication with family and friends, it transpired that 'good advice', playing the matter down, inquiries about family planning, pity and special treatment are explicitly not appreciated. LIMITATIONS, REASONS FOR CAUTION The sample was a convenience sample, so self-selection effects cannot be excluded. In addition, the level of education in the sample was above average. Accordingly, the sample cannot be regarded as representative. The results of the content analysis are based on the respondents' written answers to open-ended questions in the questionnaire. Unlike qualitative interview studies, further questioning was not possible in the case of ambiguities or to request more details. WIDER IMPLICATIONS OF THE FINDINGS Frank and sincere communication about miscarriages and about one's own emotions and needs should be promoted both in the partnership and among family members and friends in order to strengthen the potential of social support as a resource. Open communication about the different needs of both partners is necessary to create mutual understanding. The results show the importance not only of empathy and consideration for the couples concerned but also their desire not to be pitied. Striking a fine balance between fellow-feeling and pity may also lead to tension, and this potential dilemma should be addressed in psychosocial counselling. Overall, the study contributes to a better understanding of what couples want from their families and friends when they are attempting to come to terms with RPL and highlights potential challenges in the interaction between affected couples and their families and friends. STUDY FUNDING/COMPETING INTEREST(S) No funding was received for this study. None of the authors declared any conflicts of interest. TRIAL REGISTRATION NUMBER DRKS00014965. [ABSTRACT FROM AUTHOR]

Background: As health workforce policy is gaining momentum, data sources and monitoring systems have significantly improved in the European Union and internationally. Yet data remain poorly connected to policymaking and implementation and often do not adequately support integrated approaches. This brings the importance of governance and the need for innovation into play. Case: The present case study introduces a regional health workforce monitor in the German Federal State of Rhineland-Palatinate and seeks to explore the capacity of monitoring to innovate health workforce governance. The monitor applies an approach from the European Network on Regional Labour Market Monitoring to the health workforce. The novel aspect of this model is an integrated, procedural approach that promotes a 'learning system' of governance based on three interconnected pillars: mixed methods and bottom-up data collection, strong stakeholder involvement with complex communication tools and shared decision- and policy-making. Selected empirical examples illustrate the approach and the tools focusing on two aspects: the connection between sectoral, occupational and mobility data to analyse skill/qualification mixes and the supply-demand matches and the connection between monitoring and stakeholder-driven policy. Conclusion: Regional health workforce monitoring can promote effective governance in high-income countries like Germany with overall high density of health workers but maldistribution of staff and skills. The regional stakeholder networks are cost-effective and easily accessible and might therefore be appealing also to low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Background: The present crisis offers a unique opportunity to better understanding the specific contribution of the health workforce to health system resilience, and more specifically to the adaptive, absorptive and transformative capacities that influence how health systems respond to the COVID-19 pandemic. Methods: The study examined different capacities in the context of the health system as the central prerequisite of health system resilience. We compared health policies and services responses in Austria, Denmark, Germany, Italy, the Netherlands and the UK. The selection is based on differences in types of health care systems and pandemic burdens in the first wave. Country experts complied descriptive case studies using written secondary and primary sources. Results: During the first wave of the pandemic, the contribution of the health workforce rested on a broad range of capacities. The absorptive capacity concerned the freeing up capacities for newly established Covid-19 wards in hospitals. The adaptive capacity focused on increasing health workers. The transformative capacity concerned new service offerings. The influence of health systems was most visible in relation to the substantive areas of health care delivery at play, and less so in relation to the specific range of capacities of the health workforce. The lack of distinct patterns was striking, considering the inclusion of health systems, which differ on many counts. Conclusions: The study calls for a reconceptualization of the institutional perquisites of health system resilience to grasp more fully the manifold and unique health workforce contribution. Governance is the key to effective health system responses to the COVID-19 crisis, and health professions are part and parcel of governance as frontline workers and collective actors. This requires improving health workforce capacities and strengthening the integration of health professions in health governance. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemics has reinforced Germany’s role as global health player, but the education system is lagging behind and does not adequately prepare health professionals for the new challenges. This study aims to strengthen global health in undergraduate medical education in Germany. Major objectives include: to review the current situation, explore changing demand for global health and introduce innovative teaching models and the role of student as drivers for change. Methods: Mixed methods and an explorative approach were applied, comprising a scoping review, online surveys carried out at Hannover Medical School, March/April 2020, and finally a new multi-professional teaching courses initiated by students and developed collaboratively. Target groups of the survey were undergraduate medical students (n = 384) and additionally lecturers (n = 172). Results: The results reveal that new health policies and Germany’s new global political responsibility do not adequately translate into innovation in the education system. At the same time, demand for global health education has increased markedly and students have taken action bottom-up and introduced new courses. However, the transformative power on the level of institutions is limited. There is a need for appropriate funding and comprehensive governance innovation to align health and education institutions, research and education, policy and practice, and students and lecturers. Conclusions: Implementation of global health programmes illustrates how students can become change agents and enhance institutional innovation bottom-up. However, in order to achieve wider transformative potential, these efforts must be flanked by macro-level policy changes and integrated in future pandemic preparedness strategies. Key messages: Strengthening global health education is driven by students’ demand and novel teaching models. Innovation driven by students needs institutional support to achieve transformative powers. [ABSTRACT FROM AUTHOR]

One of the experimental programs at the TOF spectrometer located at the COSY-accelerator (Forschungszentrum Jülich, Germany) is the study of ω-meson production in proton proton collisions (pp → ppω). Recently, a measurement was performed with a polarized beam at an excess energy of ∊ = 129 MeV, which offers the possibility to analyze polarization observables of this reaction channel for the first time. The analyzing power (Ay) of the pp → ppω-reaction was determined to be compatible with zero. [ABSTRACT FROM AUTHOR]

The reaction $dp \ensuremath \rightarrow ppp \pi^-$ has been studied in a kinematically complete experiment at a single beam momentum $\ensuremath p_{d}=1.85$ GeV/ c ( T = 759MeV). All four ejectiles have been detected in the large-acceptance time-of-flight spectrometer COSY-TOF. We analyzed the data along the lines of the spectator model as a means to isolate the quasi-free $\ensuremath np\rightarrow pp\pi^-$ reaction. The spectator proton was identified by its momentum and flight direction thus yielding access to the associated Fermi motion of the bound neutron. A comparison is carried out with Monte Carlo simulations based on two different parameterizations of the deuteron wave function. Up to a Fermi momentum of roughly 150MeV/ c no significant deviations between experimental and simulated data of various observables were found from which we conclude that the deuteron can indeed be taken as a valid substitute for the neutron. [ABSTRACT FROM AUTHOR]

Kinematically complete measurements of the pp → ppπ0 reaction were performed for beam energies in the range 292–298MeV. We detected both protons in coincidence by using the large-acceptance COSY-TOF spectrometer and an external proton beam at COSY-Jülich; thus, we measured total and differential cross-sections and energy distributions. A strong enhancement was observed in the Dalitz plots due to the final-state interaction between the two outgoing protons; the data are well reproduced by Monte Carlo simulations using a standard scattering length of a0 = -7.83 fm and effective range of r0 = 2.8 fm. Our measured total cross-sections are roughly 50% larger than those of recent internal-target experiments at IUCF and CELSIUS. This discrepancy may be due to the final-state interaction pushing some events into the very small-angle region which is almost inaccessible to an internal-target experiment. In the angular distributions we found only very slight deviations from isotropy. The analysis of our momentum distributions yielded a small fraction of 5 ±5% for Ps or Pp wave contributions. [ABSTRACT FROM AUTHOR]

Background: Health workforce shortage in German rheumatology and its negative impact in healthcare are increasingly recognised. Health policy has increased staffing targets, but effective intervention strategies are lacking. This paper aims to systematically map the rheumatology workforce and to explore opportunities for intervention, thus contributing to better health workforce management. Methods: The WHO National Health Workforce Accounts (NHWA) provided a conceptual framework for the mapping exercise. Four major sets of indicators were selected, comprising staffing levels, health labour market flows, skill-mix and education/ training. Comparison of age-groups and time series was applied to explore trends. Public statistics and other secondary sources served the analysis, using descriptive methodology. Results: Rheumatologists nearly doubled in absolute numbers since 2000, but this trend shows a problematic demographic bias. Between 2000 and 2019 numbers increased markedly in the groups aged +50 years, but only about 9% in younger groups under 50 years. Most alarming, since 2010 the group 40 to 50 years showed a reverse trend and strong decreases. In 2019, absolute numbers of rheumatologists working in healthcare after retirement-age exceeded those aged 40 and under. Since 2015 an expanding workforce trend overall flattened, but strongest in the hospital sector; annual inflows do not show relevant growths. Conclusions: Health workforce assessment reveals negative demographic trends and decreasing appeal of the specialty especially to men, thus highlighting a need for more effective health workforce management. Intervention strategies should target innovation in resident training and task shifting and improve gender equality. Key messages: Health workforce trends indicate that new health policy planning targets cannot be met with an available stock of rheumatologist. The WHO NHWA provide a useful toolbox to map health workforce trends and identify weaknesses and gaps. [ABSTRACT FROM AUTHOR]

Background: Health workers face a higher risk of infection during the COVID-19 pandemic than the average population, yet we know very little on how protection is managed in daily practice. The aim of this study is to contribute new empirical data on the management of protection in clinical settings with a focus on surveillance, using Germany as case study. Methods: We draw on material gathered in multi-centre hospital surveillance online surveys in Germany, which are part of a national COVID-19 University Research Network (project BFAST). Selected indicators include tools, strategies and access to protection, with a focus on the composition of new surveillance teams; n = 100 responses, comprising n = 33/92% of all university medical centres; n = 67/18% of participating hospitals in two German Federal States in March 2021. Results: Three major strategies of protection were identified: expanding services, information and access for all health workers in the clinical setting; establishing novel surveillance teams to protect hospital employees comprising hotline, testing and tracing teams; creating large-scale in-house vaccination programs in accordance with national vaccination prioritisation policy of health workers. The composition of the surveillance teams showed high variation in relation to professional groups/skills and status. In particular, hospital hygienists (often with a professional background in nursing) were included in all teams, but their share varied from only 24% in testing to 60% in hotline and even 95% in tracing teams. Conclusions: German hospitals have stepped up efforts to protect health workers primarily through comprehensive surveillance and personal protection including vaccination. Our findings reveal capacity for innovation in the management of protection especially in two areas: improving the skill-mix and leadership of surveillance teams, and strengthening the role of hospital hygienists in surveillance. Key messages: The building of interdisciplinary hospital surveillance teams plays an important role in innovating surveillance and strengthening protection. The skill-mix and leadership of the surveillance teams need further research and policy investigation to improve efficiency. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic is raising new questions on public health competences and leadership and on health workforce preparedness for global public health emergencies of this magnitude. This study aims to explore the new demand and opportunities for innovation in public health competencies, which were caused by the COVID-19 crisis. Methods: We draw on secondary sources and critically review the public health competency framework recently launched by WHO and ASPHER through the lens of COVID-19. Results: The WHO-ASPHER Competency Framework for Public Health Workforce illustrates an interdisciplinary, inter-professional and lifelong learning approach to public health. Five critical competency areas can be identified in relation to global public health emergencies: (1) flexibility, adaptation, motivation, communication, (2) research, analytical sensitivity, ethics, diversity, (3) epidemiology, (4) preparedness and (5) employability. However, this may not be enough. New models of public health leadership and changes in the health workforce are needed, which transform the silos of professions and policy. Such transformations would include learning, working, leading and governing differently and must stretch far beyond the public health workforce. Innovating public health competences stretches far beyond individual competence development. Moreover, it is about resilience and preparedness and calls for learning, working, leading and governing differently. Critical public health competences are not limited to the public heath workforce, but must become relevant for all healthcare professions. Conclusions: To achieve transformative capacity, critical public health competences must be considered for all healthcare workers on all levels of policymaking, thus becoming the ‘heart’ of health workforce resilience and pandemic preparedness. Key messages: Innovating public health competencies calls for learning, working, leading and governing differently. Public health competences must be considered for all healthcare workers and transform professional silos. [ABSTRACT FROM AUTHOR]

Background: Healthcare workers face high pressures and new threats during the COVID-19 pandemic, and health systems and governance are key to improve preparedness and protection. This study aims to introduce a tool for rapid assessment based on an integrated multi-level governance approach and to empirically explore preparedness and protection. Methods: The study is explorative in nature and applies a comparative approach. The assessment tool comprises four major dimensions of governance: system, sector, occupational and sociocultural issues (focus on gender issues and migrant healthcare workers) of protection and preparedness. Secondary sources and expert information serve the empirical exercise, using material from Denmark, Germany, Portugal and Romania. Results: We revealed similar developments across countries: action has been taken to improve physical protection, vaccination of healthcare workers and digitalisation, while social and mental health support programmes were poor or lacking. Developments were more diverse in relation to occupational/ organisational preparedness: some ad-hoc transformations of work routines and tasks were observed in all countries, yet skill-mix innovation and collaboration were strong in Demark and weak in Portugal and Romania. We are able to identify major governance gaps in relation to integration of education and health systems, social and mental health support programmes, gendered issues of health workforce capacity, integration of migrant healthcare workers, and comprehensive surveillance and monitoring. Conclusions: There is a need to step up efforts and make health systems more accountable to the needs of healthcare workers during global public health emergencies. [ABSTRACT FROM AUTHOR]

Electric quadrupole transition strengths for the 2, T=1→0, T=1 γ-decay branches are summarized for 10≦ A≦42 nuclei. InB the corresponding branch has been remeasured by use of theBe( p, γ)B resonance reaction at E=320 keV; an upper limit of 0.6% is found. The variation of the E2 strengths within each individual T=1 isobaric multiplet reveals the particleor hole-character of the levels involved. The isoscalar 2→0 transition strengths in 10≦ A≦48 nuclei vary between 2 and 20 Weißkopf units showing drastic shell effects. Results for the ratio of neutron and proton matrix elements deduced from analog γ-decay studies and from inelastic pion scattering are compared. [ABSTRACT FROM AUTHOR]