The book contains 19 national reports and a comparative legal analysis of the legal regulations on the procedure of genome editing on the human germline. It is worked out which shared values the different legal systems connect and which differences exist. On this basis, it is examined whether an international regulation of the topic is possible and how it could be designed. In addition, it will be examined to what extent the regulations of other countries can serve as a model for German legislation.
Preface It’s not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change. —Charles Darwin We live in an era of rapid and unprecedented change. Driven by technological innovation and changes in the way we deliver services, the face of healthcare is undergoing a metamorphosis, shifting into a more person-based, technologically enabled, evidence-based, and responsive system. That is the theory, at least. But are health systems that are changing according to these plans heralding transformative change? And what do some of the best thinkers believe is the prole of their health system over the next 5–15 years? We believe this book represents the best attempt yet to answer those thorny questions. Very few people could reach into the health systems of 152 countries and territories and orchestrate a book of this magnitude. Jeffrey Braithwaite, as series editor, accompanied by regional editors, Russell Mannion, Yukihiro Matsuyama, Paul G. Shekelle, Stuart Whittaker, and Samir Al-Adawi, and supported by an extremely knowledgeable team at Macquarie University, Sydney, Australia, particularly Dr. Wendy James and Kristiana Ludlow, were just the team to accomplish this. The omnibus they have created is an invaluable source of predictions about the future scope and shape of health systems across low-, middle-, and highincome countries. It is a treasure trove of important information. People will use it as a practical guide to the future in many ways: it can be read for benet and learning by region, by theme, and by specic case study exemplars of the kinds of reforms people are enacting in their health systems, extrapolated across the medium-term time horizon. Most books do not do this. The fact that this group has been able to achieve this is an endorsement of the skills, efforts, ingenuity, and expertise of the editors, editorial team, and individual chapter authors. We commend this book and recommend it as a must-read to many stakeholder groups: students of the system, policy-makers, planners, futurists, and groups representing managers, clinicians, and patients—in fact, all those who have an interest in healthcare and its future success. We enjoyed dipping xii Preface into it and thinking about its many learning points. We are sure others will too. Wendy Nicklin RN, BN, MSc(A), CHE, FACHE, FISQua, ICD.D President, International Society for Quality in Health Care Clifford F. Hughes AO, MBBS, DSc, FRACS, FACS, FACC, FIACS (Hon), FAAQHC, FCSANZ, FISQua, AdDipMgt, Immediate Past President, International Society for Quality in Health Care
This book examines how Russia, the world’s most complicated country, is governed. As it resumes its place at the centre of global affairs, the book explores Russia’s overarching strategies, and how it organizes itself (or not) in policy areas ranging from foreign policy and national security to health care, education, immigration, science, sport, agriculture, the environment and criminal justice. The book also discusses the structures and institutions on which Russia relies in order to deliver its goals in these areas of national life, as well as what’s to be done, in policy terms, to improve the country’s performance in its first post-Soviet century. Edited by Irvin Studin, the book includes contributions from a tremendous list of Russia’s leading thinkers and specialists, including Alexei Kudrin, Vladimir Mau, Alexander Auzan, Simon Kordonsky, Fyodor Lukyanov, Natalia Zubarevich and Andrey Melville.
This overview report is based upon the scientific report for the Bering-Chukchi-Beaufort (BCB) region, which comprises parts of Canada, the United States and Russia. The scientific report describes current regional environmental conditions, global and regional drivers of change, and the human and ecological impacts of this change. It also emphasises is the diverse, inter-linked environmental, social and economic challenges that residents are already, or likely will be, experiencing from climate change and other regional and global-scale drivers. It considers the environmental and socio-economic changes to which inhabitants in the region are and will be adapting to. Finally, it provides a number of observations intended to help inform decision makers about how they might help their communities adapt to future changes.
The authors proposed and mathematically described model of a new type of the Fermi-Pasta-Ulam recurrence (the FPU auto recurrence) and hypothesized an adequate description of the heart's electrical dynamics within the observed phenomenon. The dynamics of the FPU auto recurrence making appropriate electrical dynamics of the normal functioning of the heart in the form of an electrocardiogram (ECG) was obtained by a computer model study. The model solutions in the form of the FPU auto recurrence – ECG Fourier spectrum were evaluated for resistance to external disturbances in the form of random effects, as well as periodic perturbation at a frequency close to the heart beating rate of about 1 Hz. In addition, in order to simulate the dynamics of myocardial infarction model, studied the effect of the surface area of the myocardium on the stability and shape of the auto recurrence – ECG spectrum. It has been found that the intense external disturbing periodic impacts at a frequency of about 1 Hz lead to a sharp disturbance spectrum shape FPU auto recurrence – ECG structure. In addition, the decrease in the surface of the myocardium by 50% in the model led to the destruction of structures of the auto recurrence – ECG, which corresponds to the state of atrial myocardium. Research models have revealed a hypothetical basis of coronary heart disease in the form of increasing the energy of high-frequency harmonics spectrum of the auto recurrence by reducing the energy of low-frequency harmonic spectrum of the auto recurrence, which ultimately leads to a sharp decrease in myocardial contractility. In order to test the hypothesis has been studied more than 20,000 ECGs both healthy people and patients with cardiovascular disease. As a result of these studies, it was found that the dynamics of the electrical activity of normal functioning of the heart can be interpreted by the display of the detected by authors the FPU auto recurrence, and coronary heart disease is a violation of the energy ratio between the low and high frequency harmonics of the FPU auto recurrence Fourier spectrum equal to the ECG spectrum. Thus, the hypothesis has been confirmed.
The materials of The International Scientific – Practical Conference is presented below. The Conference reflects the modern state of innovation in education, science, industry and social-economic sphere, from the standpoint of introducing new information technologies.
It is interesting for a wide range of researchers, teachers, graduate students and professionals in the field of innovation and information technologies.
Background and aims. This research reported here presents findings from an evaluation of the development and implementation of the Healthy Community Challenge Fund (otherwise known as the ‘Healthy Towns’ programme). A key aim of the research has been to inform the development of future environmental and systems‐based ‘whole town’ approaches to obesity prevention. The overall aim of the Healthy Towns programme was to pilot and stimulate novel ‘whole town’ approaches that tackle the ‘obesogenic’ environment in order to reduce obesity, with a particular focus on improving diet and increasing physical activity. Through a competitive tender process, nine towns were selected that represented urban areas across England ranging from small market towns to areas of large cities. The fund provided £30 million over the period 2008‐2011, divided amongst the nine towns. The amounts awarded ranged from £900,000 to £4.85 million. Towns were instructed to be innovative and were given freedom to develop a locally‐specific programme of interventions. This report supplements local process and impact evaluations undertaken by each town (not reported here) by taking an overall view of the programme’s development and implementation. Our evaluation therefore addressed the following research questions: 1. What kinds of interventions were delivered across the Healthy Towns programme? 2. Were environmental and infrastructural interventions equitably delivered? 3. How was the Healthy Towns programme theorised and translated into practice? 4. How was evidence used in the selection and design of interventions? 5. What are the barriers and facilitators to the implementation of a systems approach to obesity prevention?
Adequate assessment of individual functional motor potentials is important for developing appropriate rehabilitation strategies in ischemic stroke . Microstructural changes in corticospinal tract (CST) and corpus callosum (CC) were repeatedly correlated to post-stroke outcome [2, 3]. However, relationship between them and functional recovery remains unclear. Here we investigated relationship between integrity of CST and CC assessed with diffusion tensor imaging (DTI) and brain functional state assessed with navigated transcranial magnetic stimulation (nTMS) in chronic ischemic supratentorial stroke.
The present volume is the fourth issue of the Yearbook series entitled ‘Evolution’. The title of the present volume is ‘From Big Bang to Nanorobots’. In this way we demonstrate that all phases of evolution and Big History are covered in the articles of the present Yearbook. Several articles also present the forecasts about future development.
The main objective of our Yearbook as well as of the previous issues is the creation of a unified interdisciplinary field of research in which the scientists specializing in different disciplines could work within the framework of unified or similar paradigms, using the common terminology and searching for common rules, tendencies and regularities. At the same time for the formation of such an integrated field one should use all available opportunities: theories, laws and methods. In the present volume, a number of such approaches are used.
The volume consists of four sections: Universal Evolutionary Principles; Biosocial Evolution, Ecological Aspects, and Consciousness; Projects for the Future; In Memoriam.
This Yearbook will be useful both for those who study interdisciplinary macroproblems and for specialists working in focused directions, as well as for those who are interested in evolutionary issues of Cosmology, Biology, History, Anthropology, Economics and other areas of study. More than that, this edition will challenge and excite your vision of your own life and the new discoveries going on around us!
The book presents the most important aspects of safe digital image workflows, starting from the basic practical implications and gradually uncovering the underlying concepts and algorithms. With an easy-to-follow, down-to-earth presentation style, the text helps you to optimize your diagnostic imaging projects and connect the dots of medical informatics.
In the context of global efforts to move towards universal coverage in health systems, this report reviews health financing reforms in the Republic of Moldova and looks in particular at how the population´s access to health services has been affected. In 2004, as has been widely documented elsewhere, wholesale reforms were made to the way in which government funds were used to fund health services, shifting the system overnight from a highly fragmented and inflexible one, to one in which funds for the health sector were pooled nationally, allowing improved risk-sharing as a result of greater flexibility to allocate funds in line with health needs. A new source of funding in the form of a payroll tax for health was also introduced directly leading to a growth in total levels of government health spending. A second phase of reforms starting in 2009 addressed the issue of gaps in population coverage under mandatory health insurance, with legislative measures taken to ensure that all citizens of Moldova had access to primary health care, and to ensure that the poor receive subsidized health insurance. Fiscal constraints have limited the full implementation of these reforms however. Moldova has shown that it is prepared to tackle difficult policy issues head on and has articulated clear goals for the sector. In particular, the Roadmap “Accelerating Reforms: addressing the needs of the health area through investment policies” approved on 1 March 2012, lays a clear agenda for the next phase or priority reforms focusing on principally on service delivery reorganization but also on health financing. This is the correct focus given that progress on a number of priority indicators such as equity in access to services and financial protection has been limited in recent years. This report summarizes the main impact of health financing reforms to date and agrees with the Roadmap about the major challenges for the coming decade, in particular the need to address inefficiencies in service delivery, but also to ensure that the close link between guaranteed benefits and available funding is maintained in future policy decisions.
In the last two decades, South Africa has experienced a marginal increase in life expectancy due to high mortality burden. It coincides with variations in age- and cause-specific mortality among females and males. The study aimed at quantifying the role of age- and cause-specific mortality to the gender gap in life expectancy in South Africa from 2000 to 2015. The study measured the trends in cause-specific mortality and contributions of each cause to life expectancy among South African males and females. Andreev’s decomposition method was applied to decompose the contributions of age- and cause-specific mortality to the gender gap in life expectancy. The study revealed that recorded gender gap in life expectancy concentrated in the age group 15-34 was as a result of the differences in the contributions of the infectious diseases and external causes of mortality. In the elderly years, the gap in life expectancy among males and females were due to the variations in the contributions of mortality from circulatory and respiratory diseases. Given these, health policies and programs should target infectious diseases and external causes of death in the young adult years, the leading causes of mortality and circulatory and respiratory diseases, emerging major causes of mortality in the elderly years in South Africa
The Mauritian population has the highest life expectancy in Africa. However, diabetes, ischemic heart disease, stroke, influenza and pneumonia, and lung, breast and colon-rectum cancers are countering the health success of the country. Males, unlike females, are burdened by these diseases. The study assessed the contribution age and cause-specific mortality to the gap in life expectancy among males and females in Mauritius from 2005 to 2015. The role of the age and cause-specific mortality to life expectancy among males and females in Mauritius was decomposed using the Andreev decomposition approach. The study revealed that recorded mortality rates from diabetes, ischemic heart disease, stroke, influenza, and pneumonia were higher among males than females. Health promotion activities will need to be scaled for these causes of death especially among males to achieve national and international health goals
An individual’s subjective judgment about his or her Human Immunodeficiency Virus status depends on certain factors, behavioral, health, and sociodemographic alike. This paper aims to develop a model with good accuracy for predicting subjective HIV infection status using the random forest approach. A total of 12,796 responses of Malawians over a 12-year period were assessed. Fourteen risk factors including behavioral, health, and sociodemographic information were analysed as potential predictors of subjective Human Immunodeficiency Virus infection status in the general population and thirteen behavioral, health, and sociodemographic information were analysed among males and females. The random forest approach was adopted to build a comprehensive model comprising 14 risk factors in Malawi. It was revealed that age, worries about infection, and health rate were the most significant predictors as compared to use of condoms, marital status, and education which were the least important predictors of subjective Human Immunodeficiency Virus status in Malawi. However, the importance of infidelity on the part of a spouse and marital status as predictors of subjective Human Immunodeficiency Virus status alternated among males and females. The importance of infidelity and marital status was relatively high among females than among males. The model achieved a prediction accuracy of about 97%–99% measured by c-statistic with jack-knife cross validation and verified by Mathews correlation coefficient. As a result, RF based model has great potential to be an effective approach for analysing subjective health status
HIV disrupts host defense mechanisms and maintains chronic inflammation in the lung. Nitric oxide is a marker of lung inflammation and can be measured in the exhaled air. We investigated the relationship between exhaled nitric oxide (eNO), and airway abnormalities in perinatally HIV-infected children aged 6–19 years. In total, 222 HIV-infected and 97 HIV-uninfected participants were included. Among HIV-infected participants, 57 (25.7%) had a history of past TB; 56 (25.2%) had airway obstruction, but no prior TB. HIV status was associated with lower eNO level [mean ratio 0.79 (95% confidence interval, 95% CI 0.65–0.97), P = 0.03]. Within the HIV-infected group, history of past TB was associated with lower eNO levels after controlling for age, sex and time of eNO testing [0.79 (95% CI 0.67–0.94), P = 0.007]. HIV infection and history of TB were associated with lower eNO levels. eNO levels may be a marker of HIV and TB-induced alteration in pulmonary physiology; further studies focused on potential causes for lower eNO levels in HIV and TB are warranted.
The aim of this study was to explore health worker’s perception of using manual vacuum aspiration (MVA) 1 year after an educational intervention. The health personnel in Malawi who treat women with incomplete abortions are medical interns, clinical officers and nurses/midwives. The training was designed as a refresher course as health personnel usually are trained how to do MVA during their studies. Altogether, 53 health personnel received the training and filled out questionnaires on knowledge, attitude and practice before the training had started. After 1 year, focus group discussions were arranged with 33 of the previously trained health personnel. There was an almost equal number of nurses, clinical officers and medical interns in the survey and in the focus groups, which included fairly equal numbers of male and female participants and a good age spread among the participants. Even though the participants demonstrated knowledge on the benefits of using MVA prior to the training, most of the health personnel used curettage because of a lack of confidence, broken equipment and high gestational age of the expectant mothers. The training sessions were considered useful, but could have been extended to several days and have included actual patients. Our findings provide important insight on how to proceed in improving post-abortion care in a country where complications of unsafe abortion are common and the health system is low on resources.
One of the most worrying consequence of the production and use of persistent organohalogen pollutants (POPs) is the high accumulation in Arctic populations because of long-range transport. Study of the effects in these populations may illustrate human impacts that are difficult to assess in other locations with lower exposure to these compounds and more diverse pollutant influences.
In present study, the analyses of essential [copper (Cu), cobalt (Co), selenium (Se) and zinc (Zn)] and nonessential elements [mercury (Hg), lead (Pb), cadmium (Cd) and arsenic (As)] in 7 fish species consumed by the indigenous people of the European Russia Arctic were conducted. The Nenets Autonomous Region, which is located in the north-eastern part of European Russia, was chosen as a Region of interest. Within it, the Nenets indigenous group (n ¼ 6000) constitutes approximately 10% of the total population. Nearly all of the Nenets live a traditional life with fish caught in the local waters as a subsistence resource. We found that northern pike contained twice the amount of Hg compared with roach, and 3e4 times more than other fish species commonly consumed in the Russian Arctic (namely, Arctic char, pink salmon, navaga, humpback whitefish and inconnu). Fish Hg concentrations were relatively low, but comparable to those reported in other investigations that illustrate a decreasing south-to-north trend in fish Hg concentrations. In the current study, northern pike is the only species for which Hg bioaccumulated significantly. In all fish species, both Cd and Pb were present in considerably lower concentrations than Hg. The total As concentrations observed are similar to those previously published, and it is assumed to be present primarily in non-toxic organic forms. All fish tissues were rich in the essential elements Se, Cu and Zn and, dependent on the amount fish consumed, may contribute significantly to the nutritional intake by indigenous Arctic peoples. We observed large significant differences in the molar Se/Hg ratios, which ranged from 2.3 for northern pike to 71.1 for pink salmon. Values of the latter 1 appear to enhance the protection against Hg toxicity. © 2019 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
HIV testing among people who inject drugs (PWID) in Russia has been documented to be low; however, few studies have been conducted outside of the major metropolitan cities. The aim of this study was to determine how many PWID were aware of their HIV serostatus and what motivators were associated with getting tested for HIV.
Our analysis describes HIV testing behaviours among 593 PWID in Ivanovo and Novosibirsk, Russia. Participants completed a questionnaire and consented to HIV testing. We used logistic regression modelling to determine demographic and behavioural correlates of HIV testing.
Self-reported history of HIV testing was 52% in Ivanovo and 54% in Novosibirsk. Prior knowledge of serostatus was very low among PWID who tested positive (3 of 102 in Ivanovo and 0 of 11 in Novosibirsk). The most common reason for testing was doctor referral, and the most common locations were government HIV/AIDS centres and prisons. HIV testing was rarely client initiated or led by a personal motivation for being tested.
HIV testing in Ivanovo and Novosibirsk is suboptimal, resulting in poor knowledge of HIV serostatus. More programmes to promote HIV testing among PWID are urgently needed in both cities.
Importance Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data.
Objective To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning.
Evidence Review We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence.
Findings In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572 000 deaths and 15.2 million DALYs), and stomach cancer (542 000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819 000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601 000 deaths and 17.4 million DALYs), TBL cancer (596 000 deaths and 12.6 million DALYs), and colorectal cancer (414 000 deaths and 8.3 million DALYs).
Conclusions and Relevance The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care.