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 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.

Background

Understanding the patterns of HIV/AIDS epidemics is crucial to tracking and monitoring the progress of prevention and control efforts in countries. We provide a comprehensive assessment of the levels and trends of HIV/AIDS incidence, prevalence, mortality, and coverage of antiretroviral therapy (ART) for 1980–2017 and forecast these estimates to 2030 for 195 countries and territories.

Methods

We determined a modelling strategy for each country on the basis of the availability and quality of data. For countries and territories with data from population-based seroprevalence surveys or antenatal care clinics, we estimated prevalence and incidence using an open-source version of the Estimation and Projection Package—a natural history model originally developed by the UNAIDS Reference Group on Estimates, Modelling, and Projections. For countries with cause-specific vital registration data, we corrected data for garbage coding (ie, deaths coded to an intermediate, immediate, or poorly defined cause) and HIV misclassification. We developed a process of cohort incidence bias adjustment to use information on survival and deaths recorded in vital registration to back-calculate HIV incidence. For countries without any representative data on HIV, we produced incidence estimates by pulling information from observed bias in the geographical region. We used a re-coded version of the Spectrum model (a cohort component model that uses rates of disease progression and HIV mortality on and off ART) to produce age-sex-specific incidence, prevalence, and mortality, and treatment coverage results for all countries, and forecast these measures to 2030 using Spectrum with inputs that were extended on the basis of past trends in treatment scale-up and new infections.

Findings

Global HIV mortality peaked in 2006 with 1·95 million deaths (95% uncertainty interval 1·87–2·04) and has since decreased to 0·95 million deaths (0·91–1·01) in 2017. New cases of HIV globally peaked in 1999 (3·16 million, 2·79–3·67) and since then have gradually decreased to 1·94 million (1·63–2·29) in 2017. These trends, along with ART scale-up, have globally resulted in increased prevalence, with 36·8 million (34·8–39·2) people living with HIV in 2017. Prevalence of HIV was highest in southern sub-Saharan Africa in 2017, and countries in the region had ART coverage ranging from 65·7% in Lesotho to 85·7% in eSwatini. Our forecasts showed that 54 countries will meet the UNAIDS target of 81% ART coverage by 2020 and 12 countries are on track to meet 90% ART coverage by 2030. Forecasted results estimate that few countries will meet the UNAIDS 2020 and 2030 mortality and incidence targets.

Interpretation

Despite progress in reducing HIV-related mortality over the past decade, slow decreases in incidence, combined with the current context of stagnated funding for related interventions, mean that many countries are not on track to reach the 2020 and 2030 global targets for reduction in incidence and mortality. With a growing population of people living with HIV, it will continue to be a major threat to public health for years to come. The pace of progress needs to be hastened by continuing to expand access to ART and increasing investments in proven HIV prevention initiatives that can be scaled up to have population-level impact.

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.

Trial-to-trial variability of the motor evoked potentials (MEP) to transcranial magnetic stimulation (TMS) is a well-known phenomenon. However, the relationship between the fluctuations of the different types of the motor output and other motor system parameters such as corticospinal excitability, interhemispheric inhibition (IHI) and their interhemispheric asymmetry have not yet been fully investigated. We studied 20 young healthy right-handed volunteers. Four TMS sessions were performed (two single-pulse TMS and two paired-coil TMS with IHI paradigm sessions for each hemisphere), 70 stimuli were delivered during every session. Coefficient of quartile variation (CQV) was used to quantify trail-to-trail variability of MEPs amplitude. Resting motor threshold values were correlated between hemispheres (r = .842, p < .001). IHI phenomenon from the left hemisphere was obtained in 18 out of 20 volunteers, while IHI phenomena from the right hemisphere was shown in 16 out of 20. A strong correlation between the variability of MEP‘s amplitudes during IHI paradigm and the degree of IHI was found for the left hand (r = −.718, p < .001). We also observed a strong correlation between CQV of MEPs from both hands to single-pulse TMS (r = .632, p = .004). A side-specific correlation between the variability of the responses to single-pulse and paired-coil TMS was found for the dominant hemisphere (r = .524, p = .021). Our preliminary results demonstrate the importance of the trial-to-trial variability of the MEPs and its interhemispheric specificity as a defining characteristics of the motor system. This study was partially supported by ofi-m RFBR grant 17-29-02518, by HSE Basic Research Program and Russian Academic Excellence Project ‘5-100’.

Objective: This study is to analyze fluorescence sensitivity in the diagnosis of brain and spinal cord tumors.

Material and methods: The authors conducted a multicenter retrospective analysis of data on 653 cases in 641 patients: 553 of them had brain tumors and 88 spinal cord tumors. Brain tumor resection was performed in 523 patients, of whom 484 were adults and 39 children. The analyzed series was presented by 320 gliomas, 101 meningiomas, and 72 metastases. A stereotactic biopsy was performed in 20 patients and endoscopic surgery in 10 patients. In all cases, 20 mg/kg of 5–Aminolaevulinic acid was administered orally 2-h before surgery. All surgical interventions were performed with a microscope BLUE 400 to visualize fluorescence, while endoscopic surgery—with an endoscope equipped with a fluorescent module. Fluorescence spectroscopy was conducted in 20 cases of stereotactic biopsies and in 88 cases of spinal cord tumors.

Results: Among adult brain tumors operated by microsurgical techniques, meningiomas showed the highest 5-ALA fluorescence sensitivity 94% (n = 95/101), brain metastases 84.7% (n = 61/72), low-grade gliomas 46.4% (n = 26/56), and high-grade gliomas 90.2% (n = 238/264). In children the highest 5-ALA visible fluorescence was observed in anaplastic astrocytomas 100% (n = 4/4) and in anaplastic ependymomas 100% (n = 4/4); in low-grade gliomas it made up 31.8% (n = 7/22). As for the spinal cord tumors in adults, the highest sensitivity was demonstrated by glioblastomas 100% (n = 4/4) and by meningiomas 100% (n = 4/4); Fluorescence was not found in gemangioblastomas (n = 0/6) and neurinomas (n = 0/4). Fluorescence intensity reached 60% (n = 6/10) in endoscopic surgery and 90% (n = 18/20) in stereotactic biopsy.

Conclusion: 5-ALA fluorescence diagnosis proved to be most sensitive in surgery of HGG and meningioma (90.2 and 94.1%, respectively). Sensitivity in surgery of intracranial metastases and spinal cord tumors was slightly lower (84.7 and 63.6%, correspondingly). The lowest fluorescence sensitivity was marked in pediatric tumors and LGG (50 and 46.4%, correspondingly). Fluorescence diagnosis can also be used in transnasal endoscopic surgery of skull base tumors and in stereotactic biopsy.

The concentration of health care providers is a growing process in many countries, including Russia. There is a general expectation that larger medical entities can better promote the process of service integration

Abstract

OBJECTIVE:

The aim of this study was to explore the feasibility of different health-related quality-of-life valuation methods in a new setting. Based on a small feasibility study of 100 young Russians, we trialed different methodologies and identified key differences that have implications for the development of health technology assessment in Russia.

METHODS:

In face-to-face interviews, respondents completed a series of health self-assessments based on a modified version of the EQ-5D-3L, visual analogue scale, time tradeoff, standard gamble, and best-worst scaling methodologies, covering actual and hypothetical health states.

RESULTS:

We found that (1) the visual analogue scale produced lower health valuations and fewer logical inconsistencies than either time trade-off or standard gamble methodologies; (2) initial health states can be decisive in determining values assigned to health improvements; (3) respondents evaluate abstract health states more positively than their own actual health states; (4) there is evidence consistent with the hypothesis that actual and hypothetical health state valuation, using EQ-5D-3L, is an artifact of understanding rather than preference and that the incorporation of additional levels may therefore be no panacea if the dimensions themselves overlook important attributes; and (5) the country context is important in determining how respondents relate to the survey tools and how those survey tools are translated and delivered.

CONCLUSIONS:

Russia is commencing its health technology assessment journey and should proceed cautiously as it moves toward the valuation of health benefits. These results suggest a useful framework for a more in-depth development of health valuation methodologies in Russia.

Background: Creating visualizations that include multiple dimensions of the data while preserving spatial structure and readability is challenging. Here we demonstrate the use of geofaceting to meet this challenge.

Objective: Using data on young adult mortality in the 32 Mexican states from 1990 to 2015, we demonstrate how aligning small multiples for territorial units, often regions, according to their approximate geographical location – geofaceting – can be used to depict complex multi-dimensional phenomena.

Methods: The idea is to align small-multiples for territorial units, often regions, according to approximate geographical location. We illustrate the technique using data on young adult mortality in the 32 Mexican states from 1990 to 2015.

Results: Geofaceting reveals the macro-level spatial pattern while preserving the flexibility of choosing any visualization techniques for the small multiples. Creating geofaceted visualizations gives all the advantages of standard plots in which one can adequately display multiple dimensions of a dataset.

Contribution: Compared to other ways of small-multiples' arrangement, geofaceting improves the speed of regions' identification and exposes the broad spatial pattern.

Objectives To use the estimates from the Global Burden of Disease Study 2016 to describe patterns of suicide mortality globally, regionally, and for 195 countries and territories by age, sex, and Socio-demographic index, and to describe temporal trends between 1990 and 2016.Design Systematic analysis.Main outcome measures Crude and age standardised rates from suicide mortality and years of life lost were compared across regions and countries, and by age, sex, and Socio-demographic index (a composite measure of fertility, income, and education).Results The total number of deaths from suicide increased by 6.7% (95% uncertainty interval 0.4% to 15.6%) globally over the 27 year study period to 817 000 (762 000 to 884 000) deaths in 2016. However, the age standardised mortality rate for suicide decreased by 32.7% (27.2% to 36.6%) worldwide between 1990 and 2016, similar to the decline in the global age standardised mortality rate of 30.6%. Suicide was the leading cause of age standardised years of life lost in the Global Burden of Disease region of high income Asia Pacific and was among the top 10 leading causes in eastern Europe, central Europe, western Europe, central Asia, Australasia, southern Latin America, and high income North America. Rates for men were higher than for women across regions, countries, and age groups, except for the 15 to 19 age group. There was variation in the female to male ratio, with higher ratios at lower levels of Socio-demographic index. Women experienced greater decreases in mortality rates (49.0%, 95% uncertainty interval 42.6% to 54.6%) than men (23.8%, 15.6% to 32.7%).Conclusions Age standardised mortality rates for suicide have greatly reduced since 1990, but suicide remains an important contributor to mortality worldwide. Suicide mortality was variable across locations, between sexes, and between age groups. Suicide prevention strategies can be targeted towards vulnerable populations if they are informed by variations in mortality rates.

The present study reports alterations of task-based functional brain connectivity in a group of 11 cosmonauts after a long-duration spaceflight, compared to a healthy control group not involved in the space program. To elicit the postural and locomotor sensorimotor mechanisms that are usually most significantly impaired when space travelers return to Earth, a plantar stimulation paradigm was used in a block design fMRI study. The motor control system activated by the plantar stimulation involved the pre-central and post-central gyri, SMA, SII/operculum, and, to a lesser degree, the insular cortex and cerebellum. While no post-flight alterations were observed in terms of activation, the network-based statistics approach revealed task-specific functional connectivity modifications within a broader set of regions involving the activation sites along with other parts of the sensorimotor neural network and the visual, proprioceptive, and vestibular systems. The most notable findings included a post-flight increase in the stimulation-specific connectivity of the right posterior supramarginal gyrus with the rest of the brain; a strengthening of connections between the left and right insulae; decreased connectivity of the vestibular nuclei, right inferior parietal cortex (BA40) and cerebellum with areas associated with motor, visual, vestibular, and proprioception functions; and decreased coupling of the cerebellum with the visual cortex and the right inferior parietal cortex. The severity of space motion sickness symptoms was found to correlate with a post- to pre-flight difference in connectivity between the right supramarginal gyrus and the left anterior insula. Due to the complex nature and rapid dynamics of adaptation to gravity alterations, the post-flight findings might be attributed to both the long-term microgravity exposure and to the readaptation to Earth’s gravity that took place between the landing and post-flight MRI session. Nevertheless, the results have implications for the multisensory reweighting and gravitational motor system theories, generating hypotheses to be tested in future research.

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.