Digital Commons Network^™

Core Alzheimer’S Disease Cerebrospinal Fluid Biomarker Assays Are Not Affected By Aspiration Or Gravity Drip Extraction Methods, James D. Doecke, Cindy Francois, Christopher J. Fowler, Erik Stoops, Pierrick Bourgeat, Stephanie R. Rainey-Smith, Qiao-Xin Li, Colin L. Masters, Ralph N. Martins, Victor L. Villemagne, Steven J. Collins, Hugo Marcel Vanderstichele

Research outputs 2014 to 2021

Background: CSF biomarkers are well-established for routine clinical use, yet a paucity of comparative assessment exists regarding CSF extraction methods during lumbar puncture. Here, we compare in detail biomarker profiles in CSF extracted using either gravity drip or aspiration. Methods: Biomarkers for β-amyloidopathy (Aβ1–42, Aβ1–40), tauopathy (total tau), or synapse pathology (BACE1, Neurogranin Trunc-p75, α-synuclein) were assessed between gravity or aspiration extraction methods in a sub-population of the Australian Imaging, Biomarkers and Lifestyle (AIBL) study (cognitively normal, N = 36; mild cognitive impairment, N = 8; Alzheimer’s disease, N = 6). Results: High biomarker concordance between extraction methods was seen …

Association Of Genetic Variances In Adrb1 And Ppargc1a With Two-Kilometre Running Time-Trial Performance In Australian Football League Players: A Preliminary Study, Ysabel Jacob, Ryan S. Anderton, Jodie L. Cochrane Wilkie, Brent Rogalski, Simon M. Laws, Anthony Jones, Tania Spiteri, Nicolas H. Hart

Research outputs 2014 to 2021

Abstract: Genetic variants in the angiotensin-converting enzyme (ACE) (rs4343), alpha-actinin-3 (ACTN3) (rs1815739), adrenoceptor-beta-1 (ADRB1) (rs1801253), and peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PPARGC1A) (rs8192678) genes have previously been associated with elite athletic performance. This study assessed the influence of polymorphisms in these candidate genes towards endurance test performance in 46 players from a single Australian Football League (AFL) team. Each player provided saliva buccal swab samples for DNA analysis and genotyping and were required to perform two independent two-kilometre running time-trials, six weeks apart. Linear mixed models were created to account for repeated measures over time and to determine whether …

Using Exercise And Nutrition To Alter Fat And Lean Mass In Men With Prostate Cancer Receiving Androgen Deprivation Therapy: A Narrative Review, Rebekah L. Wilson, Dennis R. Taaffe, Robert U. Newton, Nicolas H. Hart, Philippa Lyons-Wall, Daniel A. Galvao

Research outputs 2014 to 2021

Fat mass (FM) gain and lean mass (LM) loss are common side effects for patients with prostate cancer receiving androgen deprivation therapy (ADT). Excess FM has been associated with an increased risk of developing obesity-related comorbidities, exacerbating prostate cancer progression, and all-cause and cancer-specific mortality. LM is the predominant contributor to resting metabolic rate, with any loss impacting long-term weight management as well as physical function. Therefore, reducing FM and preserving LM may improve patient-reported outcomes, risk of disease progression, and ameliorate comorbidity development. In ADT-treated patients, exercise and nutrition programs can lead to improvements in quality of life and …

Flavonoid Intake And Incident Dementia In The Danish Diet, Cancer, And Health Cohort, Catherine P. Bondonno, Nicola P. Bondonno, Frederik Dalgaard, Kevin Murray, Samantha L. Gardener, Ralph N. Martins, Stephanie R. Rainey-Smith, Aedín Cassidy, Joshua R. Lewis, Kevin D. Croft, Cecilie Kyrø, Gunnar Gislason, Augustin Scalbert, Anne Tjønneland, Kim Overvad, Jonathan M. Hodgson

Research outputs 2014 to 2021

No abstract provided.

Predictors Of Poststroke Aphasia Recovery: A Systematic Review-Informed Individual Participant Data Meta-Analysis, The Rehabilitation And Recovery Of People With Aphasia After Stroke (Release) Collaborators

Research outputs 2014 to 2021

Background and Purpose: The factors associated with recovery of language domains after stroke remain uncertain. We described recovery of overall-language-ability, auditory comprehension, naming, and functional-communication across participants’ age, sex, and aphasia chronicity in a large, multilingual, international aphasia dataset. Methods: Individual participant data meta-analysis of systematically sourced aphasia datasets described overall-language ability using the Western Aphasia Battery Aphasia-Quotient; auditory comprehension by Aachen Aphasia Test (AAT) Token Test; naming by Boston Naming Test and functional-communication by AAT Spontaneous-Speech Communication subscale. Multivariable analyses regressed absolute score-changes from baseline across language domains onto covariates identified a priori in randomized controlled trials and all …

Exercise Medicine In The Management Of Pancreatic Cancer: A Systematic Review, Hao Luo, Daniel A. Galvão, Robert U. Newton, Pedro Lopez Da Cruz, Colin Tang, Ciaran M. Fairman, Nigel Spry, Dennis R. Taaffe

Research outputs 2014 to 2021

The aim of this study was to examine the health-related effects of exercise in patients with pancreatic cancer (PanCa) through a systematic review of current evidence. Studies were obtained through searching PubMed, Web of Science, PsycINFO, Embase, CINAHL Plus, and Cochrane Library databases with additional hand searches. All intervention-based studies were included if it involved (1) adult patients with PanCa, (2) exercise training, and (3) findings in quality of life, cancer-related fatigue, psychological distress, and physical function. The review protocol was registered in PROSPERO: CRD42020154684. Seven trials described in 9 publications were included consisting of 201 patients with early-stage and …

Are We Heading For Disaster? The Problem With Resilience In Disaster Management And Recovery, Zachary Horn

Research outputs 2014 to 2021

Resilience is often construed as armour that protects individuals from stressors and harm, or a trait that allows people to ‘bounce back’ despite adversities and stressors. Although not fundamentally incorrect, these notions do not capture the true purpose, scope or power of resilience, particularly in the disaster context.

Effects Of Variations In Resistance Training Frequency On Strength Development In Well-Trained Populations And Implications For In-Season Athlete Training: A Systematic Review And Meta-Analysis, Matthew Cuthbert, G. Gregory Haff, Shawn M. Arent, Nicholas Ripley, John J. Mcmahon, Martin Evans, Paul Comfort

Research outputs 2014 to 2021

Background: In-season competition and tournaments for team sports can be both long and congested, with some sports competing up to three times per week. During these periods of time, athletes need to prepare technically, tactically and physically for the next fixture and the short duration between fixtures means that, in some cases, physical preparation ceases, or training focus moves to recovery as opposed to progressing adaptations. Objective: The aim of this review was to investigate the effect of training frequency on muscular strength to determine if a potential method to accommodate in-season resistance training, during busy training schedules, could be …

Mixed Methods Study Into Social Impacts Of Work-Related Heat Stress On Ghanaian Mining Workers: A Pragmatic Research Approach, Victor Fannam Nunfam

Research outputs 2014 to 2021

Although mixed methods research proves significant in understanding complex social phenomenon, inadequate research has explored its utility in heat exposure studies. The convergent mixed methods analysis comprising 320 surveys and two focus group interviews were used to evaluate the social impacts of occupational heat stress on Ghanaian mineworkers to enlighten policy choices for the purpose of complementarity. The study contributes to mixed methods study by affirming the practical use of between-method triangulation and complementarity. The merged quantitative and qualitative results also showed adequate corroboration and complementarity between both data, to illustrate the social impacts of work-related heat stress on mining …

Resistance Training Load Effects On Muscle Hypertrophy And Strength Gain: Systematic Review And Network Meta-Analysis, Pedro Lopez, Régis Radaelli, Dennis R. Taaffe, Robert U. Newton, Daniel A. Galvão, Gabriel S. Trajano, Juliana L. Teodoro, William J. Kraemer, Keijo Häkkinen, Ronei S. Pinto

Research outputs 2014 to 2021

Purpose This study aimed to analyze the effect of resistance training (RT) performed until volitional failure with low, moderate, and high loads on muscle hypertrophy and muscle strength in healthy adults and to assess the possible participant-, design-, and training-related covariates that may affect the adaptations. Methods Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, MEDLINE, CINAHL, EMBASE, SPORTDiscus, and Web of Science databases were searched. Including only studies that performed sets to volitional failure, the effects of low- ( > 15 repetitions maximum (RM)), moderate- (9-15 RM), and high-load ( ≤ 8 RM) RTs were examined in healthy …

Dietary Fibre Intervention For Gut Microbiota, Sleep, And Mental Health In Adults With Irritable Bowel Syndrome: A Scoping Review, Ran Yan, Lesley J. Andrew, Evania Marlow, Kanita Kunaratnam, Amanda Devine, Ian C. Dunican, Claus T. Christophersen

Research outputs 2014 to 2021

Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder affecting 4–5% of the global population. This disorder is associated with gut microbiota, diet, sleep, and mental health. This scoping review therefore aims to map existing research that has administrated fibre-related dietary intervention to IBS individuals and reported outcomes on at least two of the three following themes: gut microbiota, sleep, and mental health. Five digital databases were searched to identify and select papers as per the inclusion and exclusion criteria. Five articles were included in the assessment, where none reported on all three themes or the combination of gut …

Feasibility And Efficacy Of A Multicomponent Exercise Medicine Programme In Patients With Pancreatic Cancer Undergoing Neoadjuvant Therapy (The Expan Trial): Study Protocol Of A Dual-Centre, Two-Armed Phase I Randomised Controlled Trial, Hao Luo, Daniel A. Galvao, Robert U. Newton, Colin Tang, Andrew Dean, Kevin Jasas, Mikael Johansson, Ian Yusoff, Nigel Spry, Dennis R. Taaffe

Research outputs 2014 to 2021

Introduction Exercise is emerging as a therapy in oncology for its physical and psychosocial benefits and potential effects on chemotherapy tolerability and efficacy. However, evidence from randomised controlled trials (RCTs) supporting exercise in patients with borderline resectable or locally advanced pancreatic cancer (PanCa) undergoing neoadjuvant therapy (NAT) are lacking. Methods and analysis The EXPAN trial is a dual-centre, two-armed, phase I RCT. Forty patients with borderline resectable or locally advanced PanCa undergoing NAT will be randomised equally to an exercise intervention group (individualised exercise+standard NAT) or a usual care control group (standard NAT). The exercise intervention will be supervised and …

Human Ips Cells Engender Corneal Epithelial Stem Cells With Holoclone-Forming Capabilities, Shinya Watanabe, Ryuhei Hayashi, Yuzuru Sasamoto, Motokazu Tsujikawa, Bruce R. Ksander, Markus H. Frank, Andrew J. Quantock, Natasha Y. Frank, Kohji Nishida

Research outputs 2014 to 2021

Human induced pluripotent stem cells (hiPSCs) can generate a multiplicity of organoids, yet no compelling evidence currently exists as to whether or not these contain tissue-specific, holoclone-forming stem cells. Here, we show that a subpopulation of cells in a hiPSC-derived corneal epithelial cell sheet is positive for ABCB5 (ATP-binding cassette, sub-family B, member 5), a functional marker of adult corneal epithelial stem cells. These cells possess remarkable holoclone-forming capabilities, which can be suppressed by an antibody-mediated ABCB5 blockade. The cell sheets are generated from ABCB5+ hiPSCs that first emerge in 2D eye-like organoids around six weeks of differentiation and display …

Foveal Avascular Zone And Choroidal Thickness Are Decreased In Subjects With Hard Drusen And Without High Genetic Risk Of Developing Alzheimer’S Disease, Inés López-Cuenca, Rosa De Hoz, Celia Alcantara-Rey, Elena Salobrar-García, Lorena Elvira-Hurtado, José A. Fernández-Albarral, Ana Barabash, Federico Ramírez-Toraño, Jaisalmer De Frutos-Lucas, Juan J. Salazar, Ana I. Ramírez, José M. Ramírez

Research outputs 2014 to 2021

A family history (FH+) of Alzheimer’s disease (AD) and ɛ4 allele of the ApoE gene are the main genetic risk factors for developing AD, whereas ɛ4 allele plays a protective role in age-related macular degeneration. Ocular vascular changes have been reported in both pathologies. We analyzed the choroidal thickness using optical coherence tomography (OCT) and the foveal avascular zone (FAZ) using OCT-angiography and compared the results with ApoE gene expression, AD FH+, and the presence or absence of hard drusen (HD) in 184 cognitively healthy subjects. Choroidal thickness was statistically significantly different in the (FH−, ɛ4−, HD+) group compared with …

Physical Activity And Self-Reported Metabolic Syndrome Risk Factors In The Aboriginal Population In Perth, Australia, Measured Using An Adaptation Of The Global Physical Activity Questionnaire (Gpaq), Tuguy Esgin, Deborah Hersh, Kevin G. Rowley, Rona Macniven, Kristen Glenister, Alan Crouch, Robert U. Newton

Research outputs 2014 to 2021

Background: Complex, ongoing social factors have led to a context where metabolic syndrome (MetS) is disproportionately high in Aboriginal Australians. MetS is characterised by insulin resistance, abdominal obesity, hypertension, hypertriglyceridemia, high blood-sugar and low HDL-C. This descriptive study aimed to document physical activity levels, including domains and intensity and sedentary behaviour, and MetS risk factors in the Perth Aboriginal (predominately Noongar) community. Methods: The Global Physical Activity Questionnaire (GPAQ), together with a questionnaire on self-reported MetS risk factors, was circulated to community members for completion during 2014 (n = 129). Results: Data were analysed using chi-squared tests. The average (SD) …

An Early Collaborative Intervention Focusing On Parent-Infant Interaction In The Neonatal Period. A Descriptive Study Of The Developmental Framework, Charlotte Sahlén Helmer, Ulrika Birberg Thornberg, Evalotte Mörelius

Research outputs 2014 to 2021

Moderate to late preterm infants are at risk of developing problems later in life. To support attachment and infants’ development, high quality parent-infant interaction is important. Parent-infant interaction is known to improve through intervention programs but since no such intervention program is addressed directly to moderate to late preterm infants, a tailor-made intervention was developed. The aim was to describe the rationale, development, framework and practical provision of a new early collaborative intervention program. This study has a descriptive design and the intervention is described using the Template for Intervention Description and Replication. During an intervention-session, the preterm infant’s cues …

Wellbeing Of Breastfeeding Women In Australia And New Zealand During The Covid‐19 Pandemic: A Cross‐Sectional Study, Vanessa S. Sakalidis, Alethea Rea, Sharon L. Perrella, Jacki Mceachran, Grace Collis, Jennifer Miraudo, Stuart A. Prosser, Lisa Y. Gibson, Desiree Silva, Donna T. Geddes

Research outputs 2014 to 2021

During the COVID‐19 pandemic, breastfeeding women have experienced restricted access to support, placing them at increased risk of mental health concerns and limited breastfeeding assistance. This study investigated the effect of the pandemic on feeding choices and maternal well-being amongst breastfeeding mothers living in Australian and New Zealand. We conducted a cross-sectional online survey that examined feeding methods, maternal mental wellbeing, worries, challenges, and positive experiences during the pandemic. Most women were exclusively breastfeeding (82%). Partial breastfeeding was associated with perceived low milk supply and longer pregnancy duration during the pandemic. Reduced mental health and wellbeing was associated with lower …

Myra Potter Bregger Papers - Accession 763, Myra Potter Bregger, Unicef, American Association Of University Women

Manuscript Collection

This collection consists of the papers of Myra Potter Bregger (1905-2001), community leader and social activist, and includes personal correspondence and papers spanning over sixty years. Also included are records from various organizations with which Mrs. Bregger worked, such as UNICEF, American Association of University Women, and the South Carolina Citizens Committee on Children and Youth. Especially interesting in this collection are letters written during the Great Depression and during World War II, as well as records kept by Mrs. Bregger on her Children and Nutrition Tour in 1965.

Evaluation Of Postoperative Refractive Error Correction After Cataract Surgery, Ellen Konadu Antwi-Adjei, Emmanuel Owusu, Emmanuel Kobia-Acquah, Emmanuella Esi Dadzie, Emmanuel Anarfi, Seth Wanye

Articles

Suboptimal cataract surgery outcomes remain a challenge in most developing countries. In Ghana, about 2 million people have been reported to be blind due to cataract with about 20% new cases being recorded yearly. The aim of this study was to evaluate postoperative correction of refractive errors after cataract surgery in a selected eye hospital in Ashanti Region, Ghana. This was a retrospective study where medical records of patients (aged 40–100) who reported to an eye hospital in Ghana from 2013–2018 were reviewed. Included in the study were patients aged ≥40 years and patients with complete records. Data on patient …

Cantilever-Based Sensor Utilizing A Diffractive Optical Element With High Sensitivity To Relative Humidity, Catherine M. Grogan, Faolan Radford Mcgovern, Rory Staines, George Amarandei, Izabela Naydenova

Articles

High-sensitivity and simple, low-cost readout are desirable features for sensors independent of the application area. Micro-cantilever sensors use the deflection induced by the analyte presence to achieve high-sensitivity but possess complex electronic readouts. Current holographic sensors probe the analyte presence by measuring changes in their optical properties, have a simpler low-cost readout, but their sensitivity can be further improved. Here, the two working principles were combined to obtain a new hybrid sensor with enhanced sensitivity. The diffractive element, a holographically patterned thin photopolymer layer, was placed on a polymer (polydimethylsiloxane) layer forming a bi-layer macro-cantilever. The different responses of the …

Raman Spectroscopy Is Sensitive To Biochemical Changes Related To Various Cartilage Injuries, Rubina Shaikh, Ervin Nippolainen, Vesa Virtanen, Jari Torniainen, Lassi Rieppo, Simo Saarakkala, Isaac O. Afara, Juha Töyräs

Articles

Raman spectroscopy is promising in vivo tool in various biomedical applications; moreover, in recent years, its use for characterizing articular cartilage degeneration has been developing. It has also shown potential for scoring the severity of cartilage lesions, which could be useful in determining the optimal treatment strategy during cartilage repair surgery. However, the effect of different cartilage injury types on Raman spectra is unknown. This study aims to investigate the potential of Raman spectroscopy for detecting changes in cartilage due to different injury types. Artificial injuries were induced in cartilage samples using established mechanical and enzymatic approaches to mimic trauma-induced …

Perception Of Students And Insructors On The Impacts Of Gamification On Motivation And Teamwork Among Pharmacy Students By Using Kahoot!, Nadia Inez Junazli

Student Works (2020-2029)

There is an increased used of game-based student response system (GSRS) such as Quizziz and Kahoot! in Malaysian Pharmacy Schools where it has become a tool to increase motivation, engagement and facilitate collaborative learning. Although it is widely used in pharmacy schools across government and private Universities in Malaysia, there is little evidence to understand pharmacy students and their instructor’s perceptions and experiences on using Kahoot! in pharmacy subjects such as pharmaceutics and pharmacology. This qualitative study adopted a phenomenological approach to evaluate students’ and instructors’ experiences through in-depth interview sessions(N=11) to understand their change of attitude, experience, and perception …

Cancer Registry Newsletter Vol. 02, Cancer Registry

Cancer Registry, AKUH Archives

• Messages
• Registry Insight
• Cancer Committee Membership
• Cancer Registry AKUH-K
• Our Mission
• Cancer Registry Team
• Cancer Report
• Total Count with Gender Breakdown
• Top Ten Tumor Sites 2021
• Age-wise Distribution of Top Five Tumors
• Top Ten Male vs Female Malignancies
• Data Release
• Top Ten Malignancies in Children
• Distribution of Malignancies According to the Geographical Area of Patients
• Ongoing Projects
• Paeds Brain Tumor Registry
• Head and Neck Cancer Quality Project
• Karachi Cancer Registry
• Publication of KCR
• Achievements
• Abstracts Submitted and Published Nationally and Internationally
• St. Jude's Children's Cancer Hospital Registry Training Course
• Activities
• Annual Appreciation Organized by Oncology
• Breast Cancer Awareness Session for …

Perceptions Of Paediatric Surgeons On The Selection & Admission Processes In Master Of Paediatric Surgery : A Qualitative Study, Anand Sanmugam

Student Works (2020-2029)

The selection and intake criteria for the paediatric training surgery training program (Master of Paediatric Surgery) has undergone changes. Changes were instituted to ensure a more robust selection system to ensure that the best candidates were selected into the program. However, there has not been any data to show that these changes have resulted in selection of candidates that could graduate on time and possess the attributes that predicted the development of competencies required. The aim of this study aim was to explore the perspectives of senior paediatric surgeons on the Master of Paediatric Surgery selection and intake process. The …

Perception Of Undergraduate Medical Students On Integration Of Radiological Anatomy For Pre-Clinical Teaching, Reshma Mohamed Ansari

Student Works (2020-2029)

Integration is the way forward to enable accommodation of the ever-expanding content in medical education. While revising the curriculum, stakeholders’ perception aids to tailor a curriculum matching their needs. Radiological anatomy (RA) is an integrated discipline of topographical, cross-sectional anatomy with radiological representation of structural anatomy. Though RA has been widely incorporated in most of the medical curricula, there is a dearth of standardization in terms of student learning time (SLT), content and teachers. This study was planned to record the perception of MBBS students on RA teaching in pre-clinical years in University of Cyberjaya, Malaysia. A modified, piloted and …

Investigating The Development Of Perceptions And Behavioural Intentions Towards People Living With Hiv (Plhiv) Among Pre-Clinical Medical Students In The University Of Malaya, Calvin Christopher Willims Fernandez

Student Works (2020-2029)

Since the beginning of the HIV/AIDS epidemic in the 1980s, there has been a high prevalence of stigma and discrimination towards people living with HIV (PLHIV). They manifest in people’s attitudes and behaviour, and in various contexts including education, employment and healthcare. For the latter specifically, stigma-driven behaviours by healthcare practitioners have resulted in poorer health outcomes for PLHIV, where they are humiliated, isolated and in some cases, even refused treatment. This subsequently leads to an increase in mental health issues and other damaging health behaviours among PLHIV. Numerous studies have explored the manifestation of these stigmatizing attitudes and behaviours …

The Global Benefits Of The Law & Economics Framework In Legal Education: Using Class Simulations To Support Law Student Learning (Second In Series), Patrick H. Gaughan

Akron Law Faculty Publications

This is the second in a series of articles proposing that the globalization of markets necessitates the integration of the Law & Economics Framework into legal education. To this end, this article proposes using classroom simulations loosely based upon Garrett Hardin’s classic article, “The Tragedy of the Commons.” As proposed, the simple and flexible core simulation can easily be altered to address various types of issues while also serving as an engaging class introduction to the Law & Economics Framework. Importantly, law faculty can easily adapt the simulation to account for local sensibilities and be used without requiring a mastery …

Jacobson 2.0: Police Power In The Time Of Covid-19, James R. Steiner-Dillon

Akron Law Faculty Publications

The COVID-19 pandemic has become a legal, as well as a public health, crisis. In response to the pandemic, state and municipal governments have imposed unprecedented constraints on Americans’ daily activities. These restrictions provoked a wave of constitutional challenges that have revealed the antiquated doctrinal foundations of states’ police power in the area of public health. It has been over a century since the Supreme Court, in Jacobson v. Massachusetts, articulated a broadly deferential approach to constitutional review of state orders issued in response to a public health emergency. The constitutional order has changed since Jacobson was decided; many provisions …

Rulifying Reasonable Expectations: How Katz And Originalism Can Work Together To Create A More Determinate Fourth Amendment, Michael Gentithes

Akron Law Faculty Publications

For decades, commentators have decried the Supreme Court’s Fourth Amendment search jurisprudence as a hopelessly confusing jumble. Critics save their harshest barbs for the judicially created “reasonable expectations of privacy” test, suggesting that it provides little guidance and leaves search cases open to wide judicial discretion. Motivated by such critiques, several Justices have recently claimed that an originalist approach could replace the reasonable expectations test, limit judicial discretion, and clarify the Fourth Amendment’s meaning. This Article provides a comprehensive defense of the reasonable expectations test against originalist calls to abandon it. It notes two flaws in the originalist response. First, …

A Global Pandemic Remedy To Vaccine Nationalism, Emily Michiko Morris, Orit Fischman-Afori, Miriam Marcowitz-Bitton

Akron Law Faculty Publications

Recognizing the need for flexibility in times of emergency and building upon knowledge gained from existing international and domestic compulsory licensing laws, we propose a global, centralized scheme to provide access to vaccines during pandemics. In many ways our proposal mirrors some of the World Health Organization's (WHO) COVID-19 vaccine initiatives but consolidates and expands them into a much more efficacious form. Under the proposed model, the WHO's declaration of a pandemic would trigger a global procurement and distribution scheme for vaccines. The proposed scheme would be mandatory and would require that all countries operate as one buyer vis-a-vis vaccine …