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.

The series “Advances in Intelligent Systems and Computing” contains publications on theory, applications, and design methods of Intelligent Systems and Intelligent Computing. Virtually all disciplines such as engineering, natural sciences, computer and information science, ICT, economics, business, e-commerce, environment, healthcare, life science are covered. The list of topics spans all the areas of modern intelligent systems and computing such as: computational intelligence, soft computing including neural networks, fuzzy systems, evolutionary computing and the fusion of these paradigms, social intelligence, ambient intelligence, computational neuroscience, artificial life, virtual worlds and society, cognitive science and systems, Perception and Vision, DNA and immune based systems, self-organizing and adaptive systems, e-Learning and teaching, human-centered and human-centric computing, recommender systems, intelligent control, robotics and mechatronics including human-machine teaming, knowledge-based paradigms, learning paradigms, machine ethics, intelligent data analysis, knowledge management, intelligent agents, intelligent decision making and support, intelligent network security, trust management, interactive entertainment, Web intelligence and multimedia. The publications within “Advances in Intelligent Systems and Computing” are primarily proceedings of important conferences, symposia and congresses. They cover significant recent developments in the field, both of a foundational and applicable character. An important characteristic feature of the series is the short publication time and world-wide distribution. This permits a rapid and broad dissemination of research results.

This book contains a selection of papers accepted for the presentation and discussion at the 2018 International Conference on Digital Science (DSIC’18). This Conference had the support of the Institute of Certified Specialists, Russia, AISTI (Iberian Association for Information Systems and Technologies), and Springer. It will take place at Convention Centre, Budva, Montenegro, October 19–21, 2018. DSIC’18 is an international forum for researchers and practitioners to present and discuss the most recent innovations, trends, results, experiences, and concerns in the several perspectives of Digital Science. The main idea of this Conference is that the world of science is unified and united allowing all scientists/practitioners to be able to think, analyze, and generalize their thoughts. DSIC aims efficiently to disseminate original research results in natural, social, art, and humanities sciences. An important characteristic feature of the Conference should be the short publication time and worldwide distribution. This Conference enables fast dissemination, so conference participants can publish their papers in print and electronic format, which is then made available worldwide and accessible by numerous researchers. The Scientific Committee of DSIC’18 was composed of a multidisciplinary group of 26 experts. One hundred and seven invited reviewers who are intimately concerned with Digital Science have had the responsibility for evaluating, in a “double-blind review” process, the papers received for each of the main themes proposed for the Conference: Digital Art and Humanities; Digital Economics; Digital Education; Digital Engineering; Digital Environmental Sciences; Digital Finance, Business and Banking; Digital Media; Digital Medicine, Pharma and Public Health; Digital Public Administration; Digital Technology and Applied Sciences. DSIC’18 received 88 contributions from 16 countries around the world. The papers accepted for the presentation and discussion at the Conference are published by Springer (this book) and will be submitted for indexing by ISI, SCOPUS, among others.

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 volume contains proceedings of the first Workshop on Data Analysis in Medicine held in May 2017 at the National Research University Higher School of Economics, Moscow. The volume contains one invited paper by Dr. Svetla Boytcheva, 6 regular contributions and 2 project proposals, carefully selected and reviewed by at least two reviewers from the international program commit- tee. The papers accepted for publication report on different aspects of analysis of medical data, among them treatment of data on particular diseases (Consoli- dated mathematical growth model of Breast Cancer CoMBreC, Artificial neural networks for prediction of final height in children with growth hormone deficiency), methods of data analysis (analysis of rare diseases, methods of machine learning and Big Data, subgroup discovery for treatment optimization), and instrumental tools (explanation-oriented methods of data analysis in medicine, information support features of the medical research process, modeling frame- work for medical data semantic transformations, radiology quality management and peer-review system). Organizers of the workshop would like to thank the reviewers for their careful work and all contributors and participants of the workshop.

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 [1]. 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.

Calcium plays a role of universal cellular regulator in the living cell and one of the crucial regulators of proper fetal development during gestation. Mitochondria are important for intracellular calcium handling and signaling. Mitochondrial calcium uniporter (mtCU) is a multiprotein complex of the mitochondrial inner membrane responsible for the transport of calcium to the mitochondrial matrix. In the present study, we analyzed the expression level of mtCU components in two parts of the feto-maternal system - placenta and myometrium at full-term delivery and at preterm birth (PTB) on different stages: 22-27, 28-32, 33-36 weeks of gestation (n = 50). A gradual increase of mRNA expression and changes in protein content of MCU and MICU1 subunits were revealed in the placenta during gestation. We also observed slower depolarization rate of isolated placental mitochondria induced by Ca2+ titration at PTB. In myometrium at PTB relative gene expression level of MCU, MCUb and SMDT1 increased as compared to full-term pregnancy, but the tendency to gradual increase of MCU protein simultaneous with MCUb increase and MICU1 decline was shown in gestational dynamics. Changes observed in the present study might be considered both natural dynamics as well as possible pathological mechanisms underlying preterm birth.

Background: Chromosomal rearrangements are the typical phenomena in cancer genomes causing gene disruptions and fusions, corruption of regulatory elements, damage to chromosome integrity. Among the factors contributing to genomic instability are non-B DNA structures with stem-loops and quadruplexes being the most prevalent. We aimed at investigating the impact of specifically these two classes of non-B DNA structures on cancer breakpoint hotspots using machine learning approach.

Methods: We developed procedure for machine learning model building and evaluation as the considered data are extremely imbalanced and it was required to get a reliable estimate of the prediction power. We built logistic regression models predicting cancer breakpoint hotspots based on the densities of stem-loops and quadruplexes, jointly and separately. We also tested Random Forest models varying different resampling schemes (leave-one-out cross validation, train-test split, 3-fold cross-validation) and class balancing techniques (oversampling, stratification, synthetic minority oversampling).

Results: We performed analysis of 487,425 breakpoints from 2234 samples covering 10 cancer types available from the International Cancer Genome Consortium. We showed that distribution of breakpoint hotspots in different types of cancer are not correlated, confirming the heterogeneous nature of cancer. It appeared that stem-loop- based model best explains the blood, brain, liver, and prostate cancer breakpoint hotspot profiles while quadruplex- based model has higher performance for the bone, breast, ovary, pancreatic, and skin cancer. For the overall cancer profile and uterus cancer the joint model shows the highest performance. For particular datasets the constructed models reach high predictive power using just one predictor, and in the majority of the cases, the model built on both predictors does not increase the model performance.

Conclusion: Despite the heterogeneity in breakpoint hotspots’ distribution across different cancer types, our results demonstrate an association between cancer breakpoint hotspots and stem-loops and quadruplexes. Approximately for half of the cancer types stem-loops are the most influential factors while for the others these are quadruplexes. This fact reflects the differences in regulatory potential of stem-loops and quadruplexes at the tissue-specific level, which yet to be discovered at the genome-wide scale. The performed analysis demonstrates that influence of stem- loops and quadruplexes on breakpoint hotspots formation is tissue-specific.

Summary Background Traumatic brain injury (TBI) and spinal cord injury (SCI) are increasingly recognised as global health priorities in view of the preventability of most injuries and the complex and expensive medical care they necessitate. We aimed to measure the incidence, prevalence, and years of life lived with disability (YLDs) for TBI and SCI from all causes of injury in every country, to describe how these measures have changed between 1990 and 2016, and to estimate the proportion of TBI and SCI cases caused by different types of injury. Methods We used results from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016 to measure the global, regional, and national burden of TBI and SCI by age and sex. We measured the incidence and prevalence of all causes of injury requiring medical care in inpatient and outpatient records, literature studies, and survey data. By use of clinical record data, we estimated the proportion of each cause of injury that required medical care that would result in TBI or SCI being considered as the nature of injury. We used literature studies to establish standardised mortality ratios and applied differential equations to convert incidence to prevalence of long-term disability. Finally, we applied GBD disability weights to calculate YLDs. We used a Bayesian meta-regression tool for epidemiological modelling, used causespecific mortality rates for non-fatal estimation, and adjusted our results for disability experienced with comorbid conditions. We also analysed results on the basis of the Socio-demographic Index, a compound measure of income per capita, education, and fertility. Findings In 2016, there were 27·08 million (95% uncertainty interval [UI] 24·30–30·30 million) new cases of TBI and 0·93 million (0·78–1·16 million) new cases of SCI, with age-standardised incidence rates of 369 (331–412) per 100000 population for TBI and 13 (11–16) per 100000 for SCI. In 2016, the number of prevalent cases of TBI was 55·50 million (53·40–57·62 million) and of SCI was 27·04 million (24·98–30·15 million). From 1990 to 2016, the agestandardised prevalence of TBI increased by 8·4% (95% UI 7·7 to 9·2), whereas that of SCI did not change significantly (–0·2% [–2·1 to 2·7]). Age-standardised incidence rates increased by 3·6% (1·8 to 5·5) for TBI, but did not change significantly for SCI (–3·6% [–7·4 to 4·0]). TBI caused 8·1 million (95% UI 6·0–10·4 million) YLDs and SCI caused 9·5 million (6·7–12·4 million) YLDs in 2016, corresponding to age-standardised rates of 111 (82–141) per 100000 for TBI and 130 (90–170) per 100000 for SCI. Falls and road injuries were the leading causes of new cases of TBI and SCI in most regions. Interpretation TBI and SCI constitute a considerable portion of the global injury burden and are caused primarily by falls and road injuries. The increase in incidence of TBI over time might continue in view of increases in population density, population ageing, and increasing use of motor vehicles, motorcycles, and bicycles. The number of individuals living with SCI is expected to increase in view of population growth, which is concerning because of the specialised care that people with SCI can require. Our study was limited by data sparsity in some regions, and it will be important to invest greater resources in collection of data for TBI and SCI to improve the accuracy of future assessments.

Objectives

The study examined the smokers’ non-compliance rates in indoor public places in Russia and the sociodemographic factors associated with non-compliance.

Methods

Univariate analysis and logistic regression models were performed using cross-sectional data from a representative sample of Russian adults (N = 4006).

Results

27.2% of Russian smokers did not comply with smoke-free bans. Non-compliance was attributed to sociodemographic characteristics of smokers, mainly to the number of cigarettes smoked per day, regular alcohol consumption, being aged between 15 and 34 years, being in the highest income group and living in an urban area. Neither the sex, nor the family status of smokers exerted a statistically significant affiliation with non-compliance. Higher rates of non-compliance were observed in restaurants, cafes, bars and nightclubs, common domestic premises of apartment buildings and indoor workplaces. Violations on public transport, in governmental buildings, health and sport facilities, colleges and universities were less common.

Conclusions

There is a need to revise the methods of enforcement with respect to sociodemographic characteristics of smokers associated with non-compliance in public places where violations are widespread.

Ligation of the sphenopalatine and posterior nasal arteries is indicated for posterior epistaxis as initial treatment or when conservative measures fail. In some patients, a transnasal approach or its alternative transantral approach are not possible due to tumor filling the nasal corridor, pterygopalatine fossa, or maxillary sinus. Aim of this study was to evaluate feasibility of endoscopically assisted transoral approach for the ligation of the maxillary artery (MA). Six fresh cadaver specimens (12 sides), previously prepared with intravascular injections of colored latex, were dissected. A combined transnasal and transoral approach exposed the MA from the deep belly of the temporalis muscle laterally to its terminal branches medially. Anatomical relationships of the MA with the deep belly of the temporalis muscle and the lower head of the lateral pterygoid muscle, and feasibility of access to the MA via a transoral approach were assessed. In all specimens, the MA was found at the point where horizontal fibers of the lower head of the lateral pterygoid muscle cross the vertical fibers of the deep belly of the temporalis muscle. In 5 specimens, the artery ran anteriorly and laterally to lower head of the lateral pterygoid muscle, and in 1 specimen, it ran posteriorly and medially to this muscle, diving between its fibers. The modified endoscopically assisted transoral approach is feasible to ligate the MA. It can be used for proximal vascular control in cases when transnasal and transantral approaches are not viable.

Background The number of individuals living with dementia is increasing, negatively affecting families, communities, and health-care systems around the world. A successful response to these challenges requires an accurate understanding of the dementia disease burden. We aimed to present the first detailed analysis of the global prevalence, mortality, and overall burden of dementia as captured by the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016, and highlight the most important messages for clinicians and neurologists. Methods GBD 2016 obtained data on dementia from vital registration systems, published scientific literature and surveys, and data from health-service encounters on deaths, excess mortality, prevalence, and incidence from 195 countries and territories from 1990 to 2016, through systematic review and additional data-seeking efforts. To correct for differences in cause of death coding across time and locations, we modelled mortality due to dementia using prevalence data and estimates of excess mortality derived from countries that were most likely to code deaths to dementia relative to prevalence. Data were analysed by standardised methods to estimate deaths, prevalence, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs; computed as the sum of YLLs and YLDs), and the fractions of these metrics that were attributable to four risk factors that met GBD criteria for assessment (high body-mass index [BMI], high fasting plasma glucose, smoking, and a diet high in sugar- sweetened beverages). Findings In 2016, the global number of individuals who lived with dementia was 43·8 million (95% uncertainty interval [UI] 37·8–51·0), increased from 20.2 million (17·4–23·5) in 1990. This increase of 117% (95% UI 114–121) contrasted with a minor increase in age-standardised prevalence of 1·7% (1·0–2·4), from 701 cases (95% UI 602–815) per 100 000 population in 1990 to 712 cases (614–828) per 100 000 population in 2016. More women than men had dementia in 2016 (27·0 million, 95% UI 23·3–31·4, vs 16.8 million, 14.4–19.6), and dementia was the fifth leading cause of death globally, accounting for 2·4 million (95% UI 2·1–2·8) deaths. Overall, 28·8 million (95% UI 24·5–34·0) DALYs were attributed to dementia; 6·4 million (95% UI 3·4–10·5) of these could be attributed to the modifiable GBD risk factors of high BMI, high fasting plasma glucose, smoking, and a high intake of sugar-sweetened beverages. Interpretation The global number of people living with dementia more than doubled from 1990 to 2016, mainly due to increases in population ageing and growth. Although differences in coding for causes of death and the heterogeneity in case-ascertainment methods constitute major challenges to the estimation of the burden of dementia, future analyses should improve on the methods for the correction of these biases. Until breakthroughs are made in prevention or curative treatment, dementia will constitute an increasing challenge to health-care systems worldwide

Abstract

OBJECTIVE:

The Oxford Cognitive Screen (OCS) is a screening tool for the assessment of poststroke deficits in attention, memory, praxis, language, and number processing. The goal of the present study was to develop a Russian version of the OCS (Rus-OCS) via translation of the original battery, its cultural and linguistic adaptations, and reporting preliminary findings on its psychometric properties.

METHOD:

All parts of OCS were translated by native Russian-speaking neuropsychologists. Russian-speaking stroke patients (N = 205) were assessed with the Rus-OCS. Their performance was compared with performance of 60 healthy Russian-speaking adults aged between the ages of 18 and 91 years. The performance of 15 stroke patients and 42 healthy adults were assessed with a parallel version within 7 days of first testing. Convergent validity of the Rus-OCS was established via correlations with comparable tasks. Performance of three stroke groups with different lesion lateralization (right, left, and bilateral) was compared on language and visual attention subtasks. Preliminary normative data based on 5th to 95th percentile were also reported.

RESULTS:

Measures of internal consistency and test-retest reliability ranged from acceptable to very good and estimates of convergent validity ranged from moderate to high. Sensitivity and specificity was found to range from .56 to 1 and from .73 to 1, respectively. Significant differences in performance between stroke and healthy groups on all subtasks confirmed the discriminative power of the Rus-OCS was good.

CONCLUSIONS:

Rus-OCS is a promising cognitive screening instrument for Russian-speaking patients. However, further validation is needed. Constraints of socioeconomic differences between Russian speakers in the wider population should be considered. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

A cancer cell line originating from human epithelial colorectal adenocarcinoma (Caco-2 cells) serves as a high capacity model for a preclinical screening of drugs. Recent need for incorporating barrier tissue into multi-organ chips calls for inclusion of Caco-2 cells into microperfused environment. This article describes a series of systems biology insights obtained from comparing Caco-2 models cells grown as conventional 2D layer and in a microfluidic chip. When basic electrical parameters of Caco-2 monolayers were evaluated using impedance spectrometry and MTT assays, no differences were noted. On the other hand, the microarray profiling of mRNAs and miRNAs revealed that grows on a microfluidic chip leads to the change in the production of specific miRNA, which regulate a set of genes for cell adhesion molecules (CAMs), and provide for more complete differentiation of Caco-2 monolayer. Moreover, the sets of miRNAs secreted at the apical surface of Caco-2 monolayers grown in conventional 2D culture and in microfluidic device differ.  When integrated into a multi-tissue platform, Caco-2 cells may aid in generating insights into complex pathophysiological processes, not possible to dissect in conventional cultures.

Background

Comprehensive and comparable estimates of health spending in each country are a key input for health policy and planning, and are necessary to support the achievement of national and international health goals. Previous studies have tracked past and projected future health spending until 2040 and shown that, with economic development, countries tend to spend more on health per capita, with a decreasing share of spending from development assistance and out-of-pocket sources. We aimed to characterise the past, present, and predicted future of global health spending, with an emphasis on equity in spending across countries.

Methods

We estimated domestic health spending for 195 countries and territories from 1995 to 2016, split into three categories—government, out-of-pocket, and prepaid private health spending—and estimated development assistance for health (DAH) from 1990 to 2018. We estimated future scenarios of health spending using an ensemble of linear mixed-effects models with time series specifications to project domestic health spending from 2017 through 2050 and DAH from 2019 through 2050. Data were extracted from a broad set of sources tracking health spending and revenue, and were standardised and converted to inflation-adjusted 2018 US dollars. Incomplete or low-quality data were modelled and uncertainty was estimated, leading to a complete data series of total, government, prepaid private, and out-of-pocket health spending, and DAH. Estimates are reported in 2018 US dollars, 2018 purchasing-power parity-adjusted dollars, and as a percentage of gross domestic product. We used demographic decomposition methods to assess a set of factors associated with changes in government health spending between 1995 and 2016 and to examine evidence to support the theory of the health financing transition. We projected two alternative future scenarios based on higher government health spending to assess the potential ability of governments to generate more resources for health.

Findings

Between 1995 and 2016, health spending grew at a rate of 4·00% (95% uncertainty interval 3·89–4·12) annually, although it grew slower in per capita terms (2·72% [2·61–2·84]) and increased by less than $1 per capita over this period in 22 of 195 countries. The highest annual growth rates in per capita health spending were observed in upper-middle-income countries (5·55% [5·18–5·95]), mainly due to growth in government health spending, and in lower-middle-income countries (3·71% [3·10–4·34]), mainly from DAH. Health spending globally reached $8·0 trillion (7·8–8·1) in 2016 (comprising 8·6% [8·4–8·7] of the global economy and $10·3 trillion [10·1–10·6] in purchasing-power parity-adjusted dollars), with a per capita spending of US$5252 (5184–5319) in high-income countries, $491 (461–524) in upper-middle-income countries, $81 (74–89) in lower-middle-income countries, and $40 (38–43) in low-income countries. In 2016, 0·4% (0·3–0·4) of health spending globally was in low-income countries, despite these countries comprising 10·0% of the global population. In 2018, the largest proportion of DAH targeted HIV/AIDS ($9·5 billion, 24·3% of total DAH), although spending on other infectious diseases (excluding tuberculosis and malaria) grew fastest from 2010 to 2018 (6·27% per year). The leading sources of DAH were the USA and private philanthropy (excluding corporate donations and the Bill & Melinda Gates Foundation). For the first time, we included estimates of China's contribution to DAH ($644·7 million in 2018). Globally, health spending is projected to increase to $15·0 trillion (14·0–16·0) by 2050 (reaching 9·4% [7·6–11·3] of the global economy and $21·3 trillion [19·8–23·1] in purchasing-power parity-adjusted dollars), but at a lower growth rate of 1·84% (1·68–2·02) annually, and with continuing disparities in spending between countries. In 2050, we estimate that 0·6% (0·6–0·7) of health spending will occur in currently low-income countries, despite these countries comprising an estimated 15·7% of the global population by 2050. The ratio between per capita health spending in high-income and low-income countries was 130·2 (122·9–136·9) in 2016 and is projected to remain at similar levels in 2050 (125·9 [113·7–138·1]). The decomposition analysis identified governments’ increased prioritisation of the health sector and economic development as the strongest factors associated with increases in government health spending globally. Future government health spending scenarios suggest that, with greater prioritisation of the health sector and increased government spending, health spending per capita could more than double, with greater impacts in countries that currently have the lowest levels of government health spending.

Interpretation

Financing for global health has increased steadily over the past two decades and is projected to continue increasing in the future, although at a slower pace of growth and with persistent disparities in per-capita health spending between countries. Out-of-pocket spending is projected to remain substantial outside of high-income countries. Many low-income countries are expected to remain dependent on development assistance, although with greater government spending, larger investments in health are feasible. In the absence of sustained new investments in health, increasing efficiency in health spending is essential to meet global health targets

The aim of this work is to investigate the optimal vaccine sharing between two SIR centers in the presence of migration fluxes of susceptibles and infected individuals during the mumps outbreak. Optimality of the vaccine allocation means the minimization of the total number of lost working days during the whole period of epidemic outbreak [0,tf], which can be described by the functional Q=∫tf0I(t)dt where I(t) stands for the number of infectives at time t. We explain the behavior of the optimal allocation, which depends on the model parameters and the amount of available vaccine.

Human genetic variability is thought to account for a substantial fraction of individual biochemical characteristics — in biomedical sense, of individual drug response. However, only a handful of human genetic variants have been linked to medication outcomes. Here, we combine data on drug-protein interactions and human genome sequences to assess the impact of human variation on their binding affinity. Using data from the complexes of FDA-drugs and drug-like compounds, we predict SNPs substantially affecting the protein-ligand binding affinities. We estimate that an average individual carries ~6 SNPs affecting ~5 different FDA-approved drugs from among all of the approved compounds. SNPs affecting drug-protein binding affinity have low frequency in the population indicating that the genetic component for many ADEs may be highly personalized with each individual carrying a unique set of relevant SNPs. The reduction of ADEs, therefore, may primarily rely on the application of computational genome analysis in the clinic rather than the experimental study of common SNPs.

The paper examines the changes in the physician’s motivation at work during the period of reforms the salary system started since 2008. These reforms have included a shift from fixed salary system to pay for performance remuneration as well as sufficient increase of salary. The data of six surveys of health workers implemented in 2007-2016 were used to reveal the hierarchy of physician’s motives at work and to track their changes during the period of time under consideration. The changes were minor, and the directions of these changes were rather opposite to the expected strengthening of financial motivation at work: the importance of the motive of earning money has moved from the first place. The share of doctors willing to work more and better on the condition of linking salary with labor contribution did not increase. In contrast, almost two-thirds of physicians believe that they are working on a high level of quality and performance. The majority of physicians desire to increase not a stimulating part of the salary but a base, fixed one. Doctors who receive bonuses for the intensity, quality and performance, and who have a higher amount of salary wish to see the share of fixed part of salary higher than it is now available. This is a clear indication of orientation of this professional to strengthening the protective function of the salary rather than to use increased opportunities for earning money.

The paper explores primary health care models in Russia and in Central and Eastern European (CEE) countries. Starting with the similar model, they have taken totally different ways of primary health care transformation, including the role of general practitioner, multispecialty polyclinics and private sector. The comparison of this diversity, based on the conceptual framework of Primary Health Care Activity Monitor in Europe, demonstrated that the scores of primary care in Russia are relatively lower, particularly in the dimensions of accessibility, comprehensiveness, continuity and coordination of care. The score of the selected efficiency indicators is also relatively low. The major reasons for this are discussed, including the lack of strategic vision on the role of primary care, an excessive specialization of primary care and the delay with a shift to a general practitioner model. A debatable issue of primary care extended composition (the involvement of a growing number of specialists) is also addressed. The conceptual presumption that an extended composition presents new opportunities for more integrated care and better performance has not been supported by the evidence. Big multispecialty policlinics in Russia don’t demonstrate advantages over solo and group GP practices that dominate in CEE countries. The potential of polyclinics is not used because of the lack of specific activities for integration. It is argued that new specialists in the practices can strengthen primary care only when they support generalists rather than replace them. The lesson learnt from CEE countries is that substantial changes are needed to overcome the lagging status of primary care in Russia, including overcoming the excessive specialization of primary care, the replacement of district physicians by general practitioners, developing the forms of independent practices operating in parallel with polyclinics and competing with them.

In this work, we present a family of operational semantics that gradually approximates the realistic program behaviors in the C/C++11 memory model. Each semantics in our framework is built by elaborating and combining two simple ingredients: viewfronts and operation buffers. Viewfronts allow us to express the spatial aspect of thread interaction, i.e., which values a thread can read, while operation buffers enable manipulation with the temporal execution aspect, i.e., determining the order in which the results of certain operations can be observed by concurrently running threads.  Starting from a simple abstract state machine, through a series of gradual refinements of the abstract state, we capture such language aspects and synchronization primitives as release/acquire atomics, sequentially-consistent and non-atomic memory accesses, also providing a semantics for relaxed atomics, while avoiding the Out-of-Thin-Air problem. To the best of our knowledge, this is the first formal and executable operational semantics of C11 capable of expressing all essential concurrent aspects of the standard.  We illustrate our approach via a number of characteristic examples, relating the observed behaviors to those of standard litmus test programs from the literature. We provide an executable implementation of the semantics in PLT Redex, along with a number of implemented litmus tests and examples, and showcase our prototype on a large case study: randomized testing and debugging of a realistic Read-Copy-Update data structure.

Having one of the highest physician-population ratios in the world, Russia – paradoxically – also faces shortages of physicians. This paper explores the reasons for this paradox through examining the structural characteristics of the Russian health workforce and its development. In comparing Russia with mainstream European countries and in particular the ‘new” EU countries we argue that the shortage of physicians is determined mostly by the prevailing model of health workforce development with its enduring emphasis on quantitative rather than structural indicators. First, the traditional perception of physicians as inexpensive health resources determines the long-term growth of their jobs – irrespective of the new opportunities for substitution and other structural innovations. Second, there is a persistent distortion in the composition of physician supply, of which the most important is the very low share and narrow remit of primary health care providers in comparison to European standards. Third, the international trends in the division of labor between physicians, medical nurses and allied health personnel are not followed in Russia with the result of an inevitable overburden of physicians, the reproduction of a large supply of physicians, while also the paradoxical shortage. Fourth, the system of professional development of physicians does not match international standards. Although with a substantial delay, Russia has now started transition to a workforce model focused on structural characteristics of human resources and so, in the final part of the paper, these new initiatives of the Government are critically assessed.

Background: With the rapid growth of online social network sites (SNS), the issue of health-related online communities and its social and behavioral implications have become increasingly important for public health and healthcare. Unfortunately, online communities often become vehicles for promotion of pernicious misinformation, for example, alleged harm of vaccination or that HIV-virus is a myth (AIDS-denialism). This study seeks to explore the social structure and participants' behavior of the AIDS-denialists online community to identify and estimate the those who potentially are most susceptible to AIDS-denialists arguments  - “the risk group” in terms of becoming AIDS-denialists. Methods: Social network analysis was used for examining the most numerous AIDS-denialist community in the most popular Russian SNA “VKontakte”, which numbered 13000 – 15 000 members during the various stage of analysis. Qualitative content analysis was also used for collecting relevant for this study members’ attributes, such as HIV status and the extent of belief in AIDS-denialists arguments. Two datasets were collected to analyze friendship  relations between community members and their communication relations. Results: Using social network analysis combined with content-analysis we have identified the core of online community - cohesive and dedicated AIDS-denialists, and the risk group, which is not equal in composition to all peripheral members appeared in the online group. The risk group is the circle of users who engage with core members through online communication and may be more susceptible the AIDS-denialist propaganda. Analysis allowed to significantly reduce the target audience for possible intervention campaign and simultaneously increase the accuracy of user selection into the risk group (1369 users from the risk group is more than 10 times less than whole online group population counting over 15,000 users). Thus, online information interventions should be aimed at this risk group audience in the first place to prevent their adoption of AIDS-denialism beliefs, further spread of AIDS-denialism, and pernicious health consequences associated with being an HIV-positive AIDS-denialist. Conclusion: More research on influence of AIDS-denialism on HIV-positive online group members is needed. Of particular interest are longitudinal or case control studies that could detect the size of effect of AIDS-denialist propaganda that is communicated from hard-core denialists to the risk group, different factors associated with higher or lower susceptibility to AIDS-denialist views, and real health behavior change that occurs with becoming an AIDS-denialist.

The article is based on the preliminary results of author’s current study of the implementation of electronic health records in one of Russian outpatient clinics. Interviews with doctors, developers, managers of the State Department of Healthcare, IT-specialists, and clinic’s head, as well as observations of doctors’ everyday work, show that one of the key problems in the transition from paper to electronic record-keeping is how new information system transforms (or fails to transform) doctors’ routine, habitual activities. The article suggests that the widespread view of habitual action as an action in accordance with a preliminary scheme — a view that forms a basis for the majority of medical information systems — does not describe the actual structure of healthcare activities. The analysis of how doctors perceive and use electronic health records in their daily practice demonstrates that a situational approach to routine actions is more adequate. For example, the use of so-called “templates” that are created by doctors within the electronic health records cannot be understood without reference to the situational context of professional activities. Doctors, creating and using various “templates,” do this in such ways that allow them to make these health records circumstantially understandable. The view of routine activities as situated, concerted achievements not only proves the possibility of a new approach to the description of habitual actions’ role and place in the structure of social action, but can be important for the design and evaluation of professional information systems.

The article focuses on four major assumptions that underlie the alternative conceptualization of public recreation marketing. It explains (1) the redistribution system within recreation resources are allocated; (2) the organizational structure of recreation agencies; (3) the ways in which public recreation agencies interact with local governments and citizens; and (4) the code of ethics and its influence on the behavior of recreation professionals. Finally, the article attempts to integrate these assumptions into an alternative definition of public recreation marketing that is termed “administered marketing.”

This paper presents a method and computational technology for forecasting ambulance trips. We used statistical information about the number of the trips in 2009-2013, the meteorological archive, and the corresponding archive of the meteorological forecasts for the same period. We take into account social and meteorological predictors simultaneously. The method may be used operatively for planning in the ambulance service. It may be applied for all trips and for specific subgroups of diseases. The method and the technology may be applied for any megalopolis if the corresponding medical and meteorological information is available.

The paper considers the changes in major proximate determinants of fertility in Russia within the framework of demographic transition theory and Bongaarts approach to fertility analysis. After World War II Russian fertility became fully controlled process. The complex interplay of abortion and contraception during the Soviet period resulted in a very high abortion level. Russian government has almost never supported and promoted family planning as alternative to abortion. However couple's preferences of small offspring appeared more powerful than the will of authorities. Current trends show that albeit lack of governmental support the society itself is evolving towards more humanistic and effective birth control. Estimates made upon recent surveys' data confirm the validity of official statistics and thus the reality of favorable trend of abortion decline.