Suchergebnisse

There is a substantial burden of chronic respiratory diseases, including chronic obstructive pulmonary disease (COPD), in low- and middle-income countries (LMICs). LMICs have particular challenges in delivering cost-effective prevention, diagnosis, and management of COPD. Optimal care can be supported by effective implementation of guidelines. This American Thoracic Society workshop considered challenges to implementation of COPD guidelines in LMICs. We make 10 specific recommendations: 1) relevant organizations should provide LMIC-specific COPD management guidance; 2) patient and professional organizations must persuade policy-makers of the importance of lung function testing programs in LMICs; 3) healthcare education and training should emphasize the early-life origins of COPD; 4) urgent action is required by governments to reduce airborne exposures, including exposures to tobacco smoke and indoor and outdoor air pollution; 5) guidance for COPD in LMICs should explicitly link across Essential Medicine Lists and the World Health Organization package of essential noncommunicable disease interventions for primary health care in low-resource settings and should consider availability, affordability, sustainability, and cost-effective use of medicines; 6) the pharmaceutical industry should work to make effective COPD and tobacco-dependence medicines globally accessible and affordable; 7) implementation of locally adapted, cost-effective pulmonary rehabilitation programs should be an international priority; 8) the World Health Organization Global Action Plan for the Prevention and Control of Noncommunicable Diseases should specify how improvements in respiratory health will be achieved; 9) research funders should increase the proportion of funding allocated to COPD in LMICs; and 10) the respiratory community should leverage the skills and enthusiasm of earlier-career clinicians and researchers to improve global respiratory health.

The article analyzes the issue of determining the author and patent holder of an invention created by artificial intelligence software. The problem of determining the authorship of objects of patent law created by artificial intelligence is considered from two sides: the definition of the author of an individual under the guidance and control of which artificial intelligence has achieved a patentable result, and the recognition of the status of the inventor for the artificial intelligence itself due to the creative nature of the inventive process.
It is proved that the definition of the behavior of artificial intelligence by setting the problem and giving the necessary instructions for its solution leads to the recognition of the person giving such instructions as the inventor of the result, and artificial intelligence makes only a means to achieve the result.
It is concluded that in order to recognize the author of artificial intelligence software as the inventor of the result developed by such artificial intelligence, it is not enough for the author to take an indirect part by "training" artificial intelligence algorithms and determining the identified errors in their work. The unpredictability and non-obviousness of the decision-making process by artificial intelligence for the programmer does not allow him to recognize the inventor of the results created by the software.
At this stage of the development of artificial intelligence technology, the process of creating an invention by artificial intelligence is proposed to be considered as a revision of the parameters and characteristics existing in this field of technology, and the implementation of a choice from certain categories.

Despite the increasing interest in the determinants of adolescent undernutrition in low- and middle-income countries, a comprehensive multi-level overview at the country level is missing. Using the nationally representative 2014 Nepal Adolescent Nutrition Survey, this study aimed to provide a comprehensive overview of the sociocultural and economic determinants of stunting and thinness of adolescent boys and girls in Nepal. Multivariate logistic regression models were used to estimate the associations between multiple individual, household and community determinants and stunting and thinness among 3773 adolescents aged 10–19 years (1888 boys and 1885 girls). The prevalence rates of stunting and thinness indicated suboptimal nutritional status and an inadequate growth environment in Nepali adolescents. The results highlighted an association of paternal occupation and education, household income, number of earning household members, geographical place of residence, caste/ethnicity and nutritional knowledge with stunting, with higher odds for males and older adolescents. Paternal occupation, education, household income, geographical region, caste/ethnicity and nutrition knowledge were associated with thinness, with higher odds for males and younger adolescents. The findings underscore the importance of involving adolescents, their parents and their communities in interventions. Such interventions should not only be aimed at improving adolescent nutrition but also at optimizing adolescents' growth environment for better health and development. Future research should focus on context-specific causal pathways and mechanisms through which sociocultural and economic determinants influence nutritional outcomes within broader societal, cultural and political settings. A longitudinal approach, including a range of dietary and nutrition indicators would allow understanding how and when the relative importance of these factors change during adolescence.

The longevity of the United States' armed conflicts has resulted in a substantial portion of military personnel being at risk for post-traumatic stress disorder (PTSD). Fewer than half of veterans needing mental health services receive treatment for PTSD. For those who do receive treatment, less than one third are receiving evidence-based care. Additionally, one third of first responders develop PTSD. The need for additional treatment options is staggering. Brazilian Jiu-Jitsu (BJJ) is evaluated here as a complementary and alternative method (CAM) that promotes discipline, structure, camaraderie, concentration, and mind-body coordination. These effects are measured in terms of their impact on veterans' capacity to manage PTSD symptoms. Participants for this longitudinal study include armed-service personnel, veterans, and first responders. There were 32 participants, ranging in ages from 25 to 50 years old, with no prior BJJ training. Participants completed five questionnaires both prior to starting the study and after every 20 hours of BJJ that they completed. All participants initially displayed symptoms of PTSD, which significantly reduced over the course of the study. Participants report that the therapeutic benefits of BJJ practice include assertiveness, self-confidence, self-control, patience, empathy, empowerment, improved sleep, and mindfulness. Qualitative data was used to determine impact of these beneficial capacities to manage PTSD symptoms, and to assess the attractors that allow veterans to initiate and stick with BJJ training in community settings. These findings suggest that the inclusion of opportunities and financial support for veterans to practice BJJ as a form of somatic psychotherapy would be highly beneficial.

The mackerel (Scomber scombrus) stock is one of the commercially most important pelagic species in the Northeast Atlantic, being targeted by various nations. Environmental and stock size changes caused a stock expansion after 2007, initiating a yet unresolved dispute between the European Union, United Kingdom, Iceland, Greenland and the Faroe Islands. We analyze the impacts of different Total Allowable Catches (TACs) on the mackerel stock and possible adaptations in simulated fleet behavior by applying an age-structured bio-economic optimization and simulation model, FishRent. We implement dynamic seasonal migration patterns, which alter the spatial extension of mackerel depending on biomass levels, assuming density dependent mechanisms. If true, this is an important consideration because it may provide the possibility for major fishing parties (the European Union, Norway and the UK) to exclude minor parties (Iceland) from fishing mackerel by selecting a high enough fishing pressure and therefore keeping the stock from migrating further north. This can, for instance, be achieved by setting a corresponding TAC. When applying a TAC under a business-as-usual scenario or higher, the stock biomass decreased close to BMSY on the long-term. In this case, the Danish fleets would benefit, increasing their profit up to 80%. All other fleets were negatively affected with a profit decreasing between 50% and 100% depending on the scenario. When applying a TAC according to the stock advice, the stock biomass was estimated to increase on the long-term. This benefitted the Irish and British fleets, but effects on the Icelandic fleet were neutral.

Social media networks, such as Twitter, offer the perfect opportunity to either positively or negatively affect political attitudes on large audiences. The existence of influential users who have developed a reputation for their knowledge and experience of specific topics is a major factor contributing to this impact. Therefore, knowledge of the mechanisms to identify influential users on social media is vital for understanding their effect on their audience. The concept of the influential user is related to the concept of opinion leaders' to indicate that ideas first flow from mass media to opinion leaders and then to the rest of the population. Hence, the objective of this research was to provide reliable and accurate structural mechanisms to identify influential users, which could be applied to different platforms, places, and subjects. Twitter was selected as the platform of interest, and Saudi Arabia as the context for the investigation. These were selected because Saudi Arabia has a large number of Twitter users, some of whom are considerably active in setting agendas and disseminating ideas. The study considered the scientific methods that have been used to identify public opinion leaders before, utilizing metrics software on Twitter. The key findings propose multiple novel metrics to compare Twitter influencers, including the number of followers, social authority and the use of political hashtags, and four secondary filtering measures. Thus, using ratio and percentage calculations to classify the most influential users, Twitter accounts were filtered, analyzed and included. The structured approach is used as a mechanism to explore the top ten influencers on Twitter from the political domain in Saudi Arabia.

Trabajo presentado en la IEEE Winter Conference on Applications of Computer Vision (WACV), celebrada de forma virtual del 5 al 9 de enero de 2021 ; Recent literature addressed the monocular 3D pose estimation task very satisfactorily. In these studies, different persons are usually treated as independent pose instances to estimate. However, in many every-day situations, people are interacting, and the pose of an individual depends on the pose of his/her interactees. In this paper, we investigate how to exploit this dependency to enhance current ¿ and possibly future ¿ deep networks for 3D monocular pose estimation. Our pose interacting network, or PI-Net, inputs the initial pose estimates of a variable number of interactees into a recurrent architecture used to refine the pose of the person-of-interest. Evaluating such a method is challenging due to the limited availability of public annotated multi-person 3D human pose datasets. We demonstrate the effectiveness of our method in the MuPoTS dataset, setting the new state-of-the-art on it. Qualitative results on other multi-person datasets (for which 3D pose ground-truth is not available) showcase the proposed PI-Net. PI-Net is implemented in PyTorch and the code will be made available upon acceptance of the paper. ; This work has been partially funded by an Amazon Research Award and by the Spanish government under projects HuMoUR TIN2017-90086-R, Maria de Maeztu Seal of Excellence MDM-2016-0656, by the ANR JCJC ML3RI ANR-19-CE33-0008 and the ANR IDEX PIMPE ANR-15-IDEX-02.

Based on the meta-analysis of thematic country and comparative reports produced in the EU Horizon 2020 RESPOND project, this report seeks to revisit multilevel governance as a theoretical framework in comparative migration research. Focusing on the period of 2011-2018 where the governance of migration has been very much affected by the 'crisis' climax, we question the adaptability of multilevel governance in describing main patterns in governance, their drivers and consequences. The report problematizes the generalized notions of local, nationalist, centralist turn in migration management, instead offering more nuanced understanding that highlights the dynamism and tensions within spatial and temporal axes. Firstly, we propose that when migration is managed through and in a crisis, such as in mass migration or protracted refugee situations, actors at multilevel governance settings choose from a repertoire of possible and available actions, including strict non-admission, deterrence, restriction, ad hoc or welcoming responses. Second, we contend that four characteristics have increasingly marked the inscription of 'crisis' in the multilevel governance of migration, including: 1) complicated and fragmented legal systems, 2) multiplicity of actors, 3) re-nationalisation and restrictiveness and 4) increased complexity and uncertainty. Lastly, we conclude that multilevel governance in and through crisis inevitably leads to temporary governance models that become visible through policy convergence in strengthening restrictive measures, sophistication of remote controls, eradication of the norms and rights-based procedures of the refugee regime. The temporality of these governance modes runs the risk of governance failure and gridlocks in developing common solutions (for example, the EU's internal solidarity crisis or problems in relocation quotas).

Objectives: Review available guidance for quality assurance (QA) in mammography and discuss its contribution to harmonise practices worldwide. Methods: Literature search was performed on different sources to identify guidance documents for QA in mammography available worldwide in international bodies, healthcare providers, professional/scientific associations. The guidance documents identified were reviewed and a selection was compared for type of guidance (clinical/technical), technology and proposed QA methodologies focusing on dose and image quality (IQ) performance assessment. Results: Fourteen protocols (targeted at conventional and digital mammography) were reviewed. All included recommendations for testing acquisition, processing and display systems associated with mammographic equipment. All guidance reviewed highlighted the importance of dose assessment and testing the Automatic Exposure Control (AEC) system. Recommended tests for assessment of IQ showed variations in the proposed methodologies. Recommended testing focused on assessment of low-contrast detection, spatial resolution and noise. QC of image display is recommended following the American Association of Physicists in Medicine guidelines. Conclusions: The existing QA guidance for mammography is derived from key documents (American College of Radiology and European Union guidelines) and proposes similar tests despite the variations in detail and methodologies. Studies reported on QA data should provide detail on experimental technique to allow robust data comparison. Countries aiming to implement a mammography/QA program may select/prioritise the tests depending on available technology and resources. Main messages •An effective QA program should be practical to implement in a clinical setting. •QA should address the various stages of the imaging chain: acquisition, processing and display. •AEC system QC testing is simple to implement and provides information on equipment performance. ; info:eu-repo/semantics/publishedVersion

This commentary focuses on analyzing the potential of citizen science to address legitimacy issues in the knowledge base used to guide transformative governance in the context of the United Nation's Sustainable Development Goals (henceforth SDGs). The commentary develops two interrelated arguments for better understanding the limits of what we term "traditional" Environmental Monitoring and Assessment (EMA) as well as the potential of citizen science (CS) for strengthening the legitimacy of EMA in the local implementation of SDGs. We start by arguing that there is an urgent need for a profound renewal of traditional EMA to better implement the SDGs. Then, we present CS as a democratic innovation that provides a path to EMA renewal that incorporates, develops, and extends the role of CS in data production and use by EMA. The commentary substantiates such arguments based on current approaches to CS and traditional EMA. From this starting point, we theorize the potential of CS as a democratic innovation that can repurpose EMA as a tool for the implementation of the SDGs. With a focus on the implementation of SDG15 (Life on Land) in local contexts, the commentary presents CS as a democratic innovation for legitimate transformative governance that can affect socio-ecological transitions. We see this approach as especially appropriate to analyze the implementation of SDGs in rural settings where a specific resource nexus can create conflict-laden contexts with much potential for a renewed EMA to support transformative governance towards Agenda 2030. ; Swedish Research Council Formas 2018-02341 ; Versión publicada - versión final del editor

Background: Concerns regarding personal, professional, administrative, and institutional implications of medical assistance in dying (MAiD) are of particular interest to palliative and hospice care providers (PHCPs), who may encounter additional moral distress and professional challenges in providing end-of-life (EOL) care in the new legislative and cultural era. Objective: To explore PHCPs' encountered challenges and resource recommendations for caring for patients considering MAiD. Design: Qualitative thematic analysis of audio-recorded semistructured interviews with PHCPs. Setting/Subjects: Multidisciplinary PHCPs in acute, community, residential, and hospice care in Vancouver, Canada, with experience supporting patients who have made MAiD inquiries or requests. Measurements: Interviews were deidentified, transcribed verbatim, and coded by four researchers using a common coding scheme. Key themes were analyzed. Results: Twenty-six PHCP participants included physicians (n = 7), nurses (n = 12), social workers (n = 5), and spiritual health practitioners (n = 2). Average interview length was 52 minutes (range 35-90). Analysis revealed four broad challenges associated with providing EOL care after MAiD legalization: (1) moral ambiguity and provider distress, (2) family distress, (3) interprofessional team conflict, and (4) impact on palliative care. Participants also recommended three types of resources to support clinicians in delivering quality EOL care to patients contemplating MAiD: (1) education and training, (2) pre- and debriefing for team members, and (3) tailored bereavement support. Conclusions: PHCPs encountered multilevel MAiD-related challenges, but noted improvement in organizational policies and coordination. Resources to enhance training, pre- and debriefing, and tailored bereavement may further support PHCPs in providing high-quality EOL care as they navigate the legislative and cultural shifts. © Copyright 2021, Mary Ann Liebert, Inc.

Background: Concerns regarding personal, professional, administrative, and institutional implications of medical assistance in dying (MAiD) are of particular interest to palliative and hospice care providers (PHCPs), who may encounter additional moral distress and professional challenges in providing end-of-life (EOL) care in the new legislative and cultural era. Objective: To explore PHCPs' encountered challenges and resource recommendations for caring for patients considering MAiD. Design: Qualitative thematic analysis of audio-recorded semistructured interviews with PHCPs. Setting/Subjects: Multidisciplinary PHCPs in acute, community, residential, and hospice care in Vancouver, Canada, with experience supporting patients who have made MAiD inquiries or requests. Measurements: Interviews were deidentified, transcribed verbatim, and coded by four researchers using a common coding scheme. Key themes were analyzed. Results: Twenty-six PHCP participants included physicians (n = 7), nurses (n = 12), social workers (n = 5), and spiritual health practitioners (n = 2). Average interview length was 52 minutes (range 35-90). Analysis revealed four broad challenges associated with providing EOL care after MAiD legalization: (1) moral ambiguity and provider distress, (2) family distress, (3) interprofessional team conflict, and (4) impact on palliative care. Participants also recommended three types of resources to support clinicians in delivering quality EOL care to patients contemplating MAiD: (1) education and training, (2) pre- and debriefing for team members, and (3) tailored bereavement support. Conclusions: PHCPs encountered multilevel MAiD-related challenges, but noted improvement in organizational policies and coordination. Resources to enhance training, pre- and debriefing, and tailored bereavement may further support PHCPs in providing high-quality EOL care as they navigate the legislative and cultural shifts. © Copyright 2021, Mary Ann Liebert, Inc.

Objective: Governments worldwide have been implementing interventions aimed at improving citizens' dietary habits. Examining how individuals perceive these interventions is relevant for promoting future policies in this area, as well as informing the way they are designed and implemented. In the current study, we focused on interventions aimed at reducing sugar intake in Portugal, given the current high sugar consumption patterns in the population. Design: Online survey to assess which interventions are the most salient and receive greater public support. Setting: Portugal. Participants: 1010 (76·7 % female, M Age 36·33, sd 13·22). Results: Data from a free-recall task showed that only about one-third of participants reported knowing about these interventions, namely those related to taxation, weight restrictions in individual sugar packets and limited availability of products with high sugar content. We also found evidence of high support for the eight interventions presented (except for replacing sugar by artificial sweeteners), positive attitudes towards the need of reducing sugar intake in the Portuguese population and high agreement with the importance of reducing sugar intake across all age groups, particularly among children. Participants also indicated paying attention to the amount of sugar in their diets and a low self-reported frequency of consumption of high sugary foods and beverages. A hierarchical regression analysis suggested that these variables were significantly associated with the overall acceptance of interventions, independently of social-demographic variables (i.e., age, education and sex). Conclusion: By examining how people perceive and accept different interventions targeting the reduction of sugar intake, the current work aims to support policymaking in this domain. ; info:eu-repo/semantics/publishedVersion

Religious tourism objects in Indonesia are attractive destinations and have the potential to be fully developed. This study is an analysis of Islamic economic law on the arrangements of religious tourism in Indonesia, especially in South Sulawesi. The research method used to examine this problem is field research, utilizing interview, questionnaire, and observation techniques. This study concludes that there are dimensions of Islamic economic law in setting religious tourism. Although there is a difference of opinion on whether or not religious tourism is allowed, it should be noted that religious tourism provides benefits such as increasing the country's foreign exchange income and developing the community economy. Thus, it is necessary that the government makes regulations that emphasize the purpose of opening religious tourism to the public, including the rights and obligations of managers and visitors, as well as relevant warnings and signs. The regulations have multiple functions, including to improve the economy, to increase the number of visitors, to guarantee the protection of the right to access while maintaining the teachings of their respective religions, to eliminate doubts about the occurrence of deviations of purpose, and to strengthen inter-religious unity. The concept that can be carried out in managing religious tourism objects of different religions is by making rules that integrate arrangements for the benefit of fostering inter-religious relations so as to create harmony in a Pancasila-based society. In the study of Islamic economic law, the arrangements of religious tourism objects will have an impact on creating harmony between religious communities, increasing people's income, opening up employment opportunities, and strengthening the unity of the nation and the people.

International audience ; In Indonesia, despite two decades of burgeoning democracy, the weight of oligarchiesremains predominant in political life. Their perpetuation has been,in part, due to mediators who have been able to convert different types of resourcesthrough a multifaceted discursive, idealogical and practical repertoireand a dense network of interpersonal relationships. I focus on Alip, a politicalmediator whose trajectory has been punctuated by a succession of statuses inthe tourism, development and philanthropy sectors, and in various religious,political and economic settings. To convert resources of action and legitimacy,Alip took advantage of new political spaces offered by Indonesian democratizationand decentralization. Playing with multiple and embedded repertoiresof norms, he has simultaneously combined a high level of mobility betweeninterstitial socio-political spaces that he has helped to create and, while aimingto accumulate resources, has stabilized access to them. ; En Indonésie, malgré deux décennies d'ouverture démocratique, le poids desoligarchies reste prépondérant dans la vie politique. Leur maintien au pouvoirs'appuie sur des médiateurs susceptibles de convertir différents types de ressourcesau travers d'un répertoire discursif, idéel et pratique multiforme et d'unréseau dense de relations interpersonnelles. Je me concentre sur Alip, un médiateurpolitique dont la trajectoire fut ponctuée par une succession de statuts dansles secteurs du tourisme, du développement et de la philanthropie, et dans diversmilieux religieux, politiques et économiques. Pour convertir les ressources d'actionet de légitimité, Alip a profité de nouveaux espaces politiques offerts par ladémocratisation et la décentralisation indonésiennes. Jouant de répertoires denormes multiples et enchâssées il conjugue une forte mobilité entre des espacessociopolitiques interstitiels qu'il contribue à créer et, parallèlement, il stabilisel'accès aux ressources et vise leur accumulation.