New perspectives on brain death

2020 ◽  
pp. jnnp-2020-323952
Author(s):  
Matthew P. Kirschen ◽  
Ariane Lewis ◽  
Michael Rubin ◽  
Pedro Kurtz ◽  
David M Greer
Keyword(s):  
South America ◽  
Brain Death ◽  
Medical Futility ◽  
Global Scale ◽  
Middle Income ◽  
Middle Income Countries ◽  
Brainstem Death ◽  
Legal Challenges ◽  
The Subject ◽  
American Academy Of Neurology

Brain death, or death by neurological criteria (BD/DNC), has been accepted conceptually, medically and legally for decades. Nevertheless, some areas remain controversial or understudied, pointing to a need for focused research to advance the field. Multiple recent contributions have increased our understanding of BD/DNC, solidified our practice and provided guidance where previously lacking. There have also been important developments on a global scale, including in low-to-middle income countries such as in South America. Although variability in protocols and practice still exists, new efforts are underway to reduce inconsistencies and better train practitioners in accurate and sound BD/DNC determination. Various legal challenges have required formal responses from national societies, and the American Academy of Neurology has filled this void with much needed guidance. Questions remain regarding concepts such as ‘whole brain’ versus ‘brainstem’ death, and the intersection of BD/DNC and rubrics of medical futility. These concepts are the subject of this review.

scholarly journals Exploring Perceived Well-Being from Urban Parks: Insights from a Megacity in Latin America

2020 ◽  
Vol 12 (18) ◽  
pp. 7586
Author(s):  
Andrea Parra-Saldívar ◽  
Sebastián Abades ◽  
Juan L. Celis-Diez ◽  
Stefan Gelcich
Keyword(s):  
Native Species ◽  
Negative Impact ◽  
Urban Parks ◽  
Well Being ◽  
Developed Countries ◽  
Global Scale ◽  
Ecological Knowledge ◽  
Middle Income ◽  
Middle Income Countries ◽  
The Relationship

Urbanization has impacted biodiversity and ecosystems at a global scale. At the same time, it has been recognized as a driver of the physical and emotional gap between humans and nature. The lack of direct contact with nature can have a negative impact on several aspects of human well-being and change knowledge and attitudes of people towards the environment. However, this phenomenon is still poorly understood in megacities outside developed countries. Here, we explore the relationship between ecological knowledge and self-reported well-being in an important urban park in Santiago, Chile. We conducted semi-structured surveys of park users to explore their beliefs, preferences, ecological knowledge of plants and birds, and self-reported well-being. Citizens associated urban parks mainly with “nature,” and particularly with the presence of trees and plants. Trees were recognized as the most relevant elements of urban parks; in turn, birds were ranked as the less relevant. Regarding formal ecological knowledge, respondents correctly identified an average of 2.01 plants and 2.44 birds out of a total of 10 for each taxon, and exotic species were more likely to be recognized. Park users also reported high scores for self-reported well-being. Interestingly, variance of self-reported well-being scores tended to increase at low levels of ecological knowledge of trees, but no significant relationship was detected with knowledge of birds, nor native species. Ecological knowledge of trees was positively related to self-reported well-being. Results suggest that parks can positively contribute to bring people closer to nature in middle-income countries. Improving ecological knowledge can be critical to restore the relationship between humans and nature in megacities.

scholarly journals Foreseeable challenges in developing telesurgery for low income and middle-income countries

2021 ◽  
Vol 8 (10) ◽  
pp. 3228
Author(s):  
Vethunan Tamalvanan
Keyword(s):  
Low Income ◽  
Global Scale ◽  
Manufacturing Companies ◽  
Long Distance ◽  
Middle Income ◽  
Middle Income Countries ◽  
Surgical Services ◽  
Telerobotic Surgery ◽  
Market Status ◽  
Networking Technology

Advancement in tele surgery or long distance telerobotic surgery is an intriguing prospect achieve equitable reach of global surgical services. In realization of this dream there are multiple of challenges as to telesurgery establishment and operation in low-and middle-income countries (LMIC). As of current market status, telesurgery is costly and not practical for the austere settings in these countries. “Telesurgery for a truly global surgery” is a realisable dream for the fore coming future. Affordable robotic surgical platforms, assistance from manufacturing companies to establish robotic platforms, introduction of 5G networking technology, international collaboration to unify efforts in telesurgery, and secure networking framework for a hassle free telesurgery network; are few formidable suggestions for implementing telesurgery in a global scale.

scholarly journals The World Bank and Healthcare Reforms: A Cross‐National Analysis of Policy Prescriptions in South America

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Gabriela De Carvalho
Keyword(s):  
South America ◽  
World Bank ◽  
Healthcare Reform ◽  
Welfare States ◽  
South American ◽  
Middle Income ◽  
Middle Income Countries ◽  
Reform Legislation ◽  
National Analysis ◽  
The Impact

Recent literature on comparative welfare states has recognised the central role international financial institutions (IFIs) play in shaping social policy. Particularly in low‐ and middle‐income countries (LMICs), where constraints often lead to reliance on foreign resources, IFIs can act as agenda‐setters, transferring their ideas to vulnerable governments. The neoliberal model promoted by IFIs at the end of the 20th century reveals their influence on domestic policy in South America. This study analyses the impact of World Bank (WB) prescriptions on healthcare reform legislation in five South American countries: Argentina, Bolivia, Colombia, Paraguay, and Peru. In doing so, it attempts to answer the following questions: Are LMICs receptive to IFIs’ healthcare system prescriptions? More precisely, have WB policy prescriptions been adopted in healthcare reform legislation in South American countries? If so, in what way? Through content analysis, this study examines domestic healthcare legislation vis‐à‐vis the WB’s prescriptions. The main findings show that countries are receptive to IFIs prescriptions, making them a legitimate source of policy recommendations. Further, the results suggest a correlation between economic development and reliance on foreign resources and the degree to which countries adhere to IFIs prescriptions.

Global trends in antimicrobial resistance in animals in low- and middle-income countries

Science ◽  
2019 ◽  
Vol 365 (6459) ◽  
pp. eaaw1944 ◽  
Author(s):  
Thomas P. Van Boeckel ◽  
João Pires ◽  
Reshma Silvester ◽  
Cheng Zhao ◽  
Julia Song ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Large Scale ◽  
Protein Production ◽  
Animal Health ◽  
Scale Up ◽  
Global Scale ◽  
Animal Protein ◽  
Middle Income ◽  
Global Trends ◽  
Middle Income Countries

The global scale-up in demand for animal protein is the most notable dietary trend of our time. Antimicrobial consumption in animals is threefold that of humans and has enabled large-scale animal protein production. The consequences for the development of antimicrobial resistance in animals have received comparatively less attention than in humans. We analyzed 901 point prevalence surveys of pathogens in developing countries to map resistance in animals. China and India represented the largest hotspots of resistance, with new hotspots emerging in Brazil and Kenya. From 2000 to 2018, the proportion of antimicrobials showing resistance above 50% increased from 0.15 to 0.41 in chickens and from 0.13 to 0.34 in pigs. Escalating resistance in animals is anticipated to have important consequences for animal health and, eventually, for human health.

Why Do Some Countries Get Better WTO Accession Terms Than Others?

2011 ◽  
Vol 65 (4) ◽  
pp. 639-672 ◽  
Author(s):  
Krzysztof J. Pelc
Keyword(s):  
Institutional Design ◽  
Market Access ◽  
Good Deal ◽  
Middle Income ◽  
Middle Income Countries ◽  
Trade Regimes ◽  
The Subject ◽  
Level I ◽  
The One ◽  
Key Industries

AbstractThe process by which countries accede to the World Trade Organization (WTO) has become the subject of considerable debate. This article takes a closer look at what determines the concessions the institution requires of an entrant. In other words, who gets a good deal, and who does not? I argue that given the institutional design of accession proceedings and the resulting suspension of reciprocity, accession terms are driven by the domestic export interests of existing members. As a result, relatively greater liberalization will be imposed on those entrants that have more valuable market access to offer upon accession, something that appears to be in opposition to expectations during multilateral trade rounds, where market access functions as a bargaining chit. The empirical evidence supports these assertions. Looking at eighteen recent entrants at the six-digit product level, I find that controlling for a host of country-specific variables, as well as the applied protection rates on a given product prior to accession, the more a country has to offer, the more it is required to give. Moreover, I show how more democratic countries, in spite of their greater overall depth of integration, exhibit greater resistance to adjustment in key industries than do nondemocracies. Finally, I demonstrate that wealth exhibits a curvilinear effect. On the one hand, institutionalized norms lead members to exercise observable restraint vis-à-vis the poorest countries. On the other hand, the richest countries have the greatest bargaining expertise, and thus obtain better terms. The outcome, as I show using a semi-parametric analysis, is that middle-income countries end up with the most stringent terms, and have to make the greatest relative adjustments to their trade regimes.

scholarly journals Global infectious disease research collaborations in crises: building capacity and inclusivity through cooperation

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Jonathon P. Fanning ◽  
Srinivas Murthy ◽  
Nchafatso G. Obonyo ◽  
J. Kenneth Baillie ◽  
Steve Webb ◽  
...  
Keyword(s):  
International Research ◽  
Research Collaboration ◽  
Global Scale ◽  
Main Body ◽  
International Research Collaboration ◽  
Middle Income ◽  
Building Capacity ◽  
Middle Income Countries ◽  
Research Collaborations ◽  
Low And Middle Income

Abstract Background The initial research requirements in pandemics are predictable. But how is it possible to study a disease that is so quickly spreading and to rapidly use that research to inform control and treatment? Main body In our view, a dilemma with such wide-reaching impact mandates multi-disciplinary collaborations on a global scale. International research collaboration is the only means to rapidly address these fundamental questions and potentially change the paradigm of data sharing for the benefit of patients throughout the world. International research collaboration presents significant benefits but also barriers that need to be surmounted, especially in low- and middle-income countries. Conclusion Facilitating international cooperation, by building capacity in established collaborative platforms and in low- and middle-income countries, is imperative to efficiently answering the priority clinical research questions that can change the trajectory of a pandemic.

News & Views Ethical Standards For Clinical Trials Conducted In Third Countries: The New Strategy of the European Medicines Agency

2011 ◽  
Vol 18 (1) ◽  
pp. 65-75 ◽  
Author(s):  
Annagrazia Altavilla
Keyword(s):  
Clinical Trials ◽  
Clinical Research ◽  
Global Scale ◽  
European Medicines Agency ◽  
Ethical Standards ◽  
European Economic Area ◽  
Ethical Aspects ◽  
Middle Income ◽  
Middle Income Countries ◽  
New Strategy

AbstractClinical trials increasingly occur on a global scale as industry and government sponsors in wealthy countries move trials to low- and middle-income countries. The globalization of clinical research raises important questions about the economical and ethical aspects of clinical research and the translation of trial results to clinical practice: which ethical standards are applied? Are trials results accurate and valid, and can they be extrapolated to other settings? This article provides an overview of the strategy approved by the European Medicines Agency (EMA) to clarify ethical standards for clinical research conducted outside the European Economic Area (EEA) and included in Marketing Authorization Applications. Reference to the EMA Reflection paper is made.

scholarly journals Ongoing worldwide homogenization of human pathogens

2014 ◽  
Author(s):  
Timothée Poisot ◽  
Charles Nunn ◽  
Serge Morand
Keyword(s):  
Infectious Diseases ◽  
Geographical Area ◽  
Global Scale ◽  
Human Pathogens ◽  
Middle Income ◽  
Middle Income Countries ◽  
Worldwide Distribution ◽  
Graph Theoretical Approach ◽  
Rate Of Emergence ◽  
The 1960S

Infectious diseases are a major burden on human population, especially in low- and middle-income countries. The increase in the rate of emergence of infectious outbreaks necessitates a better understanding of the worldwide distribution of diseases through space and time. We analyze 100 years of records of diseases occurrence worldwide. We use a graph-theoretical approach to characterize the worldwide structure of human infectious diseases, and its dynamics over the Twentieth Century. Since the 1960s, there is a clear homogenizing of human pathogens worldwide, with most diseases expanding their geographical area. The occurrence network of human pathogens becomes markedly more connected, and less modular. Human infectious diseases are steadily expanding their ranges since the 1960s, and disease occurrence has become more homogenized at a global scale. Our findings emphasize the need for international collaboration in designing policies for the prevention of outbreaks.

Deindustrialization and Unsustainable Debt in Middle-Income Countries: The Case of Puerto Rico

2017 ◽  
Vol 8 (2) ◽  
Author(s):  
Jose Caraballo-Cueto ◽  
Juan Lara
Keyword(s):  
Puerto Rico ◽  
Debt Crisis ◽  
Sharp Decrease ◽  
Municipal Bond ◽  
Federal Programs ◽  
Middle Income ◽  
Middle Income Countries ◽  
Weak Evidence ◽  
History Of ◽  
The Subject

Abstract Puerto Rico recently became the largest bankruptcy case in the history of the U.S. municipal bond market. This debt crisis has not been the subject of significant scrutiny in the economic literature, though many researchers focus on case studies, such as Greece and Argentina, to analyze a country’s indebtedness. The underlying economic factors that influence unsustainable debt in upper middle-income countries are generally understudied. We attempted to contribute to filling these gaps in the related literature. Using econometric analysis, we found that Puerto Rico’s government indebtedness is, to a large extent, connected to a sharp decrease in manufacturing employment (i.e. deindustrialization) suffered by this economy, and weak evidence that it was caused by an excessive government payroll or overgenerous federal programs. In light of our empirical results, we discussed how the consequences of deindustrialization ultimately led to increase government borrowing.

scholarly journals Dietary intakes of women during pregnancy in low- and middle-income countries

2012 ◽  
Vol 16 (8) ◽  
pp. 1340-1353 ◽  
Author(s):  
Sun Eun Lee ◽  
Sameera A Talegawkar ◽  
Mario Merialdi ◽  
Laura E Caulfield
Keyword(s):  
Developing Countries ◽  
South America ◽  
Pregnant Women ◽  
Food Consumption ◽  
Dietary Intakes ◽  
Middle Income ◽  
Middle Income Countries ◽  
The Caribbean ◽  
Central South ◽  
Low And Middle Income

AbstractObjectiveTo provide a better understanding of dietary intakes of pregnant women in low- and middle-income countries.DesignSystematic review was performed to identify relevant studies which reported nutrient intakes or food consumption of pregnant women in developing countries. Macronutrient and micronutrient intakes were compared by region and the FAO/WHO Estimated Average Requirements. Food consumption was summarized by region.SettingDeveloping countries in Africa, Asia, and the Caribbean and Central/South America.SubjectsPregnant women in the second or third trimester of their pregnancies.ResultsFrom a total of 1499 retrieved articles, sixty-two relevant studies were analysed. The ranges of mean/median intakes of energy, fat, protein and carbohydrate were relatively higher in women residing in the Caribbean and Central/South America than in Africa and Asia. Percentages of energy from carbohydrate and fat varied inversely across studies in all regions, whereas percentage of energy from protein was relatively stable. Among selected micronutrients, folate and Fe intakes were most frequently below the Estimated Average Requirements, followed by Ca and Zn. Usual dietary patterns were heavily cereal based across regions.ConclusionsImbalanced macronutrients, inadequate micronutrient intakes and predominantly plant-based diets were common features of the diet of pregnant women in developing countries. Cohesive public health efforts involving improving access to nutrient-rich local foods, micronutrient supplementation and fortification are needed to improve the nutrition of pregnant women in developing countries.

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