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Krause F, Boldt J, editors. Care in Healthcare: Reflections on Theory and Practice [Internet]. Cham (CH): Palgrave Macmillan; 2018. doi: 10.1007/978-3-319-61291-1_4

Cover of Care in Healthcare

Care in Healthcare: Reflections on Theory and Practice [Internet].

Fundamentals of an ethics of care.

Giovanni Maio .

Affiliations

Published online: July 20, 2017.

Medical ethics initially dedicated itself to principlism, which promised manageability of ethical problems. Only gradually, it was realised that the principlistic approach was biased and one-sided, because many medical-ethical problems do not break down to abstract principles. Due to this new understanding, complementary methodical approaches to medical ethics evolved. One of the most prominent alternative approaches is that of ethics of care. Giovanni Maio presents in details the basic elements of ethics of care, primarily by recourse to Paul Ricoeur. In a second part, he sets out the relevance of care for an adequate handling of medical-ethical problems.

  • Care: Connecting Virtue and Practice

The ethics of care, or care ethics, developed in the field of bioethics, primarily in response to the lack of context and the rationalist approach of principlism. Care ethics takes an approach which consciously distances itself from principlism and the idea that ethical problems can be solved by means of abstract principles and instead develops its own concepts. What, then, are the specific characteristics of care ethics? The starting point for the formulation of an ethics of care was undoubtedly the book In a Different Voice ( 1982 ) by Carol Gilligan. In this book Gilligan pursues a theory of “two views of morality” and defines care as a specifically female virtue or disposition. Until now care ethics has thus been seen above all in its relation to feminist ethics, raising the issue of the relationship between care and so-called female morals. This restrictive definition in terms of an “ethics of gender” is not of great help in respect of the medical-ethical implications. It seems more important to reflect instead on the basic characteristics of care ethics, for example on the necessity, underlined by Gilligan , of being there for a person in order to realise care, on her emphasis on the network of relationships that binds us to others, and on the primacy of inner judgement and the personal approach, instead of external obligations. Gilligan’s radicalised shift of focus to inner judgement and the personal approach provoked direct criticism and brought out alternative voices. For example, the political scientist Joan Tronto understands care not primarily as virtue, but rather as practice (Tronto 1993 ); she makes it clear that care cannot be achieved through good intentions alone, but can only be considered to have been carried out when these good intentions have actually resulted in some kind of effect on the other person (Table 1 ). Tronto thus developed a four-phase model of care:

Table 1

Tronto’s four-phase model with the corresponding ethical elements of an ethics of care, modified according to Conradi (2001)

A model such as this is initially illuminating, because it locates care in connection with attitude and action, with outlook and deeds. But such lists (which are not entirely free of trivialities) cannot hide the fact that they are unable to replace theory or methodical reflection. There is a lot to be said for understanding care ethics not so much as a method unto itself but as something that brings a specific point of view to situations and problems. An example of this deeper reflection can be found in Paul Ricœur.

Care According to Paul Ricœur

In his late work Oneself as Another , Paul Ricœur defines care explicitly as a part of humans’ ethical duty. He neatly summarises the content of care when he stresses that care is about being “with the other and for them”. He thus understands care in one sense as interaction with the other and at the same time as referring to them. This double reference brings together the two essential aspects of care. Drawing on the Aristotelian concept of friendship, Ricœur focuses on the fact that care is grounded in reciprocity. He thus categorically rejects Emmanuel Levinas’ one-sided appeal to care that extends from the other to us, underlining the reciprocity of the care relationship. Care is not oriented in one direction towards the person who receives care. The person providing care also changes as a result. By confronting the unfamiliarity of the care receiver, the care provider expands their own horizons. It is thus care that enables them to find their own identity in unfamiliarity. In care, what was previously seen as self-evident as well as one’s view of the world and the self—made one-sided through routine—are broken down and exposed. According to Ricœur, care has a mediating function in that the care provider, in order to really show care, must enter “foreign ground”, become distanced from themself, in order to be able to broaden their own standpoint and vantage point. 1 Ricœur thus makes an original connection which goes beyond the link between care and finding one’s personal identity to also connect care to the valuable asset of self-esteem: our image of ourselves is formed above all through dialogue with others. By providing care for the other, our own self gains a layer of unfamiliarity, which helps us not only to see ourselves more clearly but also to value ourselves more. At the same time, for Ricœur, caring is always linked to a recollection of our own vulnerability, and this reminder, in which we experience ourselves as being “related” to the person in need of help, triggers a process of change in the giver. Thus through the simple fact of making their need for help known, the care receiver becomes the giver by opening up the care provider to experiences that would otherwise have been denied to them. The awareness of being “related” or “similar” (as Ricœur also says) to the person receiving care, in connection with the fundamental attitude that there is a “reversibility” of the roles in the provision of care, leads to an effort to compensate for the obvious asymmetry and create equality. For Ricœur, care is thus a crucial motivator in the “search for equality in the midst of inequality” (Ricœur 1992 , p. 192). It represents a call for increased equality, for the abolition of one-sided thinking, and for the facilitation of reciprocity. In pursuing these goals, an inner identification with the other and “the shared admission of fragility” are needed (Ricœur 1992 , p. 192).

For Ricœur, care is thus a reciprocal phenomenon, because it is only realised when a response is given—that is through the reference to a demand—which in turn depends on active questioning and on a response supported by kindness and consideration. Ricœur describes this response to the other’s requirement as a fundamental willingness, “by which the self makes itself available to others” (Ricœur 1992 , p. 168). He also defines this process of making oneself available and the related openness to the particular nature of the other as a disposition to kindness (Ricœur 1992 , p. 189). This disposition lies at the heart of care. The other can initiate a new situation and self-esteem, so long as the care provider is sensitive to the demand that they have made. Ricœur calls the acceptance of the associated responsibility “striving for the good of the other”.

At one point, Ricœur also expresses this conception of care in connection with the concept of “benevolent spontaneity”, making it clear that care is an interaction which must be supported by a certain fundamental disposition: the disposition of goodwill. Ricœur thus links his conception of care back to motivational contents and emotional factors which present themselves in the immediacy of the interaction with the person in need of care. Care is hence conceived of as a combination of (1) reflexivity (self-awareness), (2) intentionality (being oriented towards the other), (3) affectivity (goodwill), and (4) spontaneity (immediacy).

Systematics of the Core Elements of an Ethics of Care

Now that we have drawn on Paul Ricœur to discuss one of the most well-founded conceptions of care, our focus will turn to developing a more general understanding of care ethics. We have seen that there certainly are differing conceptions, but, all differences aside, a closer look reveals some underlying characteristics which can shed light on the particular nature of care ethics.

Anthropology of Dependence

A central feature of care ethics is the anthropology on which it is based. This anthropology was originally developed as a counterreaction to a form of ethics that (like the principlism described here) focuses on the individual as a sovereign being with the right to self-defence. Care ethics does not, of course, negate the need to respect these rights, but rests upon a different view of humanity. Rather than on the sovereignty of each individual, it focuses on their fundamental dependence. Practising care ethics means recognising that each individual lives within a basic structure of dependence, whether or not they are conscious of this dependence (which was also Gilligan’s basic idea). Care ethics thus takes as its point of departure an awareness of the asymmetry of the situation in which people in need of help or care find themselves. Their situation is not so much based on reciprocity but on a reflection of a fundamental state of dependence inherent to all human beings. And it is also this situation that makes care necessary as a form of action constituting a response to this fundamental trait of dependence. What distinguishes care ethics, however, is not just that it acknowledges asymmetry and thus dependence. It also frees this dependence from its negative connotations: from the perspective of care ethics, needing help is not considered an imperfection, but rather something normal and generally paradigmatic for relationships.

In this context, asymmetry does not refer to the cementing of a benevolent paternalism. Instead, it concerns the recognition that although the situation may be one of inequality, this does not negate the postulate of an equal level of respect and of equality between people. In other words, an ethics of care acknowledges the different degrees of sovereignty that a person may have in their particular situation, but without relativising on any level the fundamental equality of all humans in their moral rights and relationships of recognition. Its ultimate aim (as we saw with Ricœur) is instead, at the same time, to balance out the asymmetry of sovereignty by means of the equality of the people involved.

Being in Relationships

Relationships play a crucial role in care ethics in three regards. Firstly, they are based on a concept of anthropology that does not just perceive humans as dependent beings but also interprets them as beings oriented towards relationships with other humans. Relationships are a fundamental feature of human existence. Secondly, relationships are seen as playing a significant role in the development of ethical problems, particularly with regard to a lack of relationships. For care ethics, relationships thus become a prism through which to view ethical problems. Finally, relationships are also a crucial strategy for resolving such conflicts. Against this background it is clear why care ethics makes reference to the crucial importance of human connectedness in resolving ethical problems. This relational approach to ethics also involves an appreciation of other virtues that have a stabilising effect on relationships, such as forbearance and forgiveness or devotion and trust. Care ethics thus places significantly more value on affective connections and prioritises interactive actions for resolving ethical conflicts.

However, since promoting relationships as a solution to every problem would not be appropriate either, a nuanced approach is required here. It is not unusual for the entanglement in relationships itself to cause problems for patients, for example when they find themselves in a situation of dependence and need help extracting themselves in order to resolve the problem. For the people providing help, this focus on relationships is also always a balancing act, since they must guard against becoming too emotionally involved and ultimately burning themselves out. This is where we begin to see the limits of expecting too much of relationships when it comes to providing solutions. Nonetheless, the emphasis on the moral dimension of relationships and the appreciation of virtues which make relationships more stable are two of the crucial elements at the heart of an ethics of care.

Being Situation-Oriented

A key issue with regard to care ethics is that of the reason or justification for a particular action or reaction. While principlism adopts a deductive approach here, deriving action from abstract principles (and justifying it by way of these principles), care ethics takes a fundamentally different path. Rather than basing its actions on an abstract rule and moving from here to practice, it takes practice itself as the foundation for selecting the action required. It thus does not follow a deductive model, but instead sees the immediacy and singularity of a particular situation as an instruction to decide on the action that seems most appropriate in that situation. Thus, while principlism applies rules, care ethics is concerned with a fitting response that must be developed based on the situation, since the specific nature of a situation cannot be confronted adequately simply by applying rules. This shows that, in terms of method alone, care ethics is not concerned with the criterion of generalisability or with a Kantian idea of universalism; rather, it focuses on understanding the particular and incomparable nature of the patient and their situation. Generalisability is replaced by singularity and particularity. This is reminiscent of hermeneutic ethics insofar as the particular point of view of care ethics lies specifically in inquiring into the particular and thus the unique nature of the other. It is therefore no coincidence that the hermeneutist Ricœur of all people advocates an ethics of care, nor that—drawing on the Aristotelian concept of phronesis—he identifies “practical wisdom” as the methodical basis for ethical judgements. Ricœur wanted care to be understood as a guarantee that the unique nature of the other is protected against being taken over by generalising postulates. He sees the fundamental role of care in saving the otherness of the other.

emphasis on immediacy and acknowledgement of immediate perception

recognition of the singularity of the situation

need for a creative resolution to conflict rather than one that is simply rule-based.

Care ethics thus represents a progressive alternative to simple instrumental rationality.

Responsiveness

In the light of the above, the distinguishing feature of care ethics is that it is defined less by initiative than by responsiveness. It responds or reacts to the needs of the person who is dependent on help. Care ethics is primarily response-focused. It is the other who calls for care. Thus care ethics is linked to the attitude and gestures of “turning to” somebody and necessitates the capacity to approach the other. This requires an attitude of listening, of receptiveness, of understanding, essentially of close attention . Here, too, we can see a similarity with hermeneutic ethics, although care ethics involves more than just understanding; it contains the impulse to change, to realise care (Maio 2015 ). This impulse to realise care can be understood as the impulse to implement the response we are urged to give by the urgent situation of the other. In this context, Emmanuel Levinas defined care as “being called on” by the other.

Accepting the Indefinable

As care ethics does not aim to be rule-based and instead takes the specific situation as its point of departure, the demand made on the result of the ethical judgement is also entirely different. Ethics based on deductive reasoning demands exactitude and unambiguousness, following the motto: Is this permitted or not permitted? Required or not required? Right or wrong? Care ethics does not apply these categories, which constitutes another similarity with hermeneutic ethics. Instead, it is characterised by a tolerance for ambiguity; as it takes seriously the specific features of each situation, it cannot predict what is right and what is wrong. A situation may remain ambivalent until the last moment. But care ethics does not see ambivalence as a state that should be abolished by any means—paying attention to, allowing and bearing ambivalence are part and parcel of the methodical approach of an ethics of care. In other words: from the epistemology of particularity comes an acceptance of ambiguity. There is no one correct solution, but rather a spectrum of solutions; there is no single right answer, but rather what is appropriate in each case, and there is also no objective solution that is connected with a universalistic pretension. Instead, it is a case of the particular and thus the always fallible.

Giving Preference to Emotional Knowledge

The above criteria show that care ethics differs from other forms of ethics above all in the way in which problems are perceived. It perceives the ethical problem in different terms, which are not just related to the above basic elements, but rest more fundamentally on a wider concept of knowledge. For care ethics, knowing the objectifiable and formalisable facts does not suffice; care ethics also draws on what could be called “implicit knowledge”. The critical role of relationships, the demand for an adequate perception of the situation, and the prioritising of creative solutions over deductive inference necessitate implicit forms of knowledge such as experiential knowledge, situational knowledge, and relationship knowledge. Valuing these forms of knowledge, which go beyond the confines of a formal-logical approach, is the essence of care ethics. They are forms of knowledge that cannot be learnt by heart but must be practised. According to care ethics, competence could be described as skill in dealing with ambiguity. The ability to cope with complexity plays a significantly more constitutive role here than in other forms of ethics. This perhaps also explains why the medical community continues to give little importance or support to care ethics. Care ethics represents a counterpoint to operational rationality because it practices a rationality of its own, in which feelings, intuition, and sensations are just as important as calculations, and in which experience is ascribed an epistemological value which is overlooked in the structural logic of modern medicine.

In this regard, care ethics is more progressive than many forms of principlism, because it does away with the prejudice of the irrationality of feeling, because it takes the knowledge content of feelings seriously and in this respect constitutes an implicit plea to place more value on emotional knowledge. The specific challenge of care ethics, on the other hand, is to take this emotional knowledge seriously in such a way that it is not set in opposition to cognitive knowledge. A healthy balance must be struck between both forms of knowledge, placing more value on emotional knowledge as a creative factor while cognitive knowledge remains present in the same way as a constant check and balance. Care ethics can only truly bear fruit when it draws on emotional knowledge to enable unique and creative approaches without being absolved of the obligation to justify such creative solutions with transparent and comprehensible arguments.

Giving Preference to Space for Growth

Care ethics does not just expand the above-described form of knowledge and insights; its core elements also open up an alternative view of how to deal with ethical problems. Where the focus of care ethics lies in perceiving the complexity of an ethical problem, and where this complexity or ambiguity necessitates a more receptive approach, the response to the problem will also be evaluated using entirely different criteria than those used when focusing on structural functionality. There is a similarity to hermeneutic ethics here in that it is not rapid, confident action that counts, but rather a tentative and considerate approach. This entails a different definition of good actions, one where the guiding values are careful reflection and prudence. It was Carol Gilligan herself, the initiator of the care ethics debate, who emphasised hesitation and tentative consideration as indicators of care, and, as we saw above, Paul Ricœur also talks explicitly of consideration. Precisely because care ethics assumes that there are no unambiguous solutions, it attributes more value to doubt; the attitude of tentative hesitation has no trace here of the negative connotations that are necessarily attached to it in the constant bustle of large medical institutions. This confers on care ethics nothing short of a subversive power in relation to action as well. This subversive power can be extremely restorative because it can give rise to the insight that good medicine means not simply doing things but also allowing these things space to thrive. This praxeology of caution could make it possible to rediscover the value of giving things space to thrive, to mitigate the tendency towards actionism, and to introduce a way of thinking that makes a clearer distinction between medicine (as care) and industry (as production site).

  • Limits of Care Ethics

It has become clear that care ethics renounces a universalistic pretension and instead turns towards the unique and the particular. It thus constitutes a necessary correction to the prevalent hegemony of the structural-functional approach. However, renouncing universalistic pretensions inevitably raises the objection that care becomes arbitrary and relative. This reproach can only be refuted by making it clear that individual decisions are taken within a predefined framework, which is not invalidated by the particularity of a situation but remains in place as a constitutive framework.

A second criticism has already been discussed above. The fundamental significance that care ethics attributes to relationships and attention also has the potential, in some situations, to place excessive demands both on the treatment team and on the patient. Sometimes a patient has no desire to enter into a relationship, but simply wants to make use of a service. This objection can be fundamentally rejected using care ethics itself, since an ethics of care, understood correctly, should take its specific starting point seriously in such a way that in the case of doubt it recognises that a particular situation requires a distanced approach based more on principlism or ethics of ought. This highlights once again the fact that care ethics represents a very particular approach to ethical problems which cannot and should not be the most appropriate solution to all situations and medical-ethical problems. Care ethics is only as good as the way in which it is applied. It will only be beneficial when it is applied to problems for which it is the most suitable method. In contrast, attempts to elevate it to the level of a medical-ethical paradigm will inevitably result in shortcomings, not in care ethics itself but in the diligence that is applied when choosing it as the method to be used in specific contexts and situations.

  • Conclusions

Care ethics developed as a reaction to the one-sided thinking of principlism and duty ethics or, as it is sometimes called, ethics of justice. This context has induced polarisation which obscures the fact that both care ethics and principlism are needed. They are not alternative models; they must be allowed to complement one another. In order for medicine to do justice to a patient, there must be an awareness of principles and basic rights and of the significance of a principle as abstract as that of human dignity. That much is indisputable. But on its own it is no guarantee that the patient will truly be helped. In order to help the patient in their specific situation, it is necessary to take a highly individualised approach and develop a strategy that will really help that person. Such a strategy cannot be reduced to adapting rules or limited to subjective arbitrariness. It demands an individual approach to a specific person within a predefined framework. The value of care ethics lies its assumption that the dependence of the other demands the personal acceptance of responsibility. This acceptance of responsibility (the crucial role of the “response” should be borne in mind here) goes beyond ensuring basic rights.

Care ethics, whose core aspects we have highlighted above, thus enriches ethics, makes it more stimulating, and brings to it greater substance that cannot easily be codified. But the specific richness of this substance can only fully develop when it is firmly located within a fixed framework of principles which is not in opposition to care ethics but on the contrary is what finally enables care ethics to be realised. Paul Ricœur neatly summarises this complementary relationship when he emphasises that the power of judgement which is so crucial for care “consists in inventing conduct that will best satisfy the exception required by solicitude, by betraying the rule to the smallest extent possible” (Ricœur 1992 , p. 269).

  • Conradi, E. (2001). Take Care. Grundlagen einer Ethik der Achtsamkeit . Frankfurt am Main: Campus.
  • Gilligan, C. (1982). In a Different Voice . Harvard: Harvard University Press.
  • Honneth, A. (1996). The Struggle for Recognition: The Moral Grammar of Social Conflicts . Cambridge: The MIT Press.
  • Maio, G. (2015). Den kranken Menschen verstehen. Für eine Medizin der Zuwendung . Freiburg: Alber.
  • Ricœur, P. (1992). Oneself as Another. (K. Blamey, Trans.). Chicago: University of Chicago Press.
  • Tronto, J. C. (1993). Moral Boundaries: A Political Argument for an Ethic of Care . London: Routledge.

Axel Honneth takes a similar approach when, referring to the granting of care, he formulates the possibility of a “decentred perspective” (Honneth, 1996 , p. 74).

Open Access  This chapter is licensed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

The images or other third party material in this chapter are included in the chapter’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the chapter’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

  • Cite this Page Maio G. Fundamentals of an Ethics of Care. 2017 Jul 20. In: Krause F, Boldt J, editors. Care in Healthcare: Reflections on Theory and Practice [Internet]. Cham (CH): Palgrave Macmillan; 2018. doi: 10.1007/978-3-319-61291-1_4
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  • Care According to Paul Ricœur
  • Systematics of the Core Elements of an Ethics of Care

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Health Care Ethics, Essay Example

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The ethical dilemma in the high costs of health care is a controversial subject. Step-by-step reforms have certainly brought about some useful changes over the past few decades, but this approach has also allowed the costs of Medicare, Medicaid, and private insurance to rise to levels previously unimagined and which are unarguably burdensome on the nation’s economy. (Faden 2013)

The HCA seems to be taking a step in the right direction regarding this concern. Plans for sweeping changes to healthcare delivery and financing often represent some very sophisticated thinking by smart and well-intentioned people, but those plans often call for leaps of faith that involve political vulnerabilities fostered by the attitudinal and institutional constraints discussed here. Appeals to moral suasion are only so powerful. President Obama often invoked the language of the absolute imperative of major reform, telling audiences that “the status quo is untenable,” and “everybody understands we can’t keep doing what we are doing.” (Faden 2013)

Another ethical dilemma in the health care industry is the problem of understaffed medical facilities. It would be impossible to calculate a perfect staff level to patient ratio due to all of the unforeseen circumstances and emergencies in the health care industry. It is unfortunate that the HCA owned these eight hospitals mentioned, so they, as well as other medical centers, should move forward in improving their balance of quality and efficiency. The notion “you get what you pay for” does not seem very ethical to the general stakeholders in health care. Not everybody has the money to pay for their treatments and there needs to be better ways to cover them as everybody deserves the opportunity for health care treatment. It would be easier for health care institutions to expand to corporations for stakeholders that offer them fair and reasonable costs in health care. (Tilburt 2013)

Faden, R. R., Kass, N. E., Goodman, S. N., Pronovost, P., Tunis, S., & Beauchamp, T. L. (2013). An ethics framework for a learning health care system: a departure from traditional research ethics and clinical ethics. Hastings Center Report ,  43 (s1), S16-S27.

Tilburt, J. C., Wynia, M. K., Sheeler, R. D., Thorsteinsdottir, B., James, K. M., Egginton, S., … & Goold, S. D. (2013). Views of US physicians about controlling health care costs.  Jama ,  310 (4), 380-389.

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Essay on Medical Ethics

Students are often asked to write an essay on Medical Ethics in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

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100 Words Essay on Medical Ethics

What is medical ethics.

Medical ethics is a set of rules that doctors and healthcare workers follow to give the best care to patients. It’s like a guide for making sure everyone is treated fairly and kindly in medical situations.

Respecting Patients

One big part of medical ethics is respecting patients. This means doctors must listen to patients, keep their information private, and let them make choices about their own health.

Doing No Harm

Doctors promise to not hurt patients. They must be careful and avoid causing any harm while trying to help. This is a very old rule in medicine, known as “do no harm.”

Medical ethics also means being fair. Doctors should treat everyone the same, no matter who they are. They must give the same high-quality care to all patients.

Staying Honest

Honesty is key in medical ethics. Doctors should always tell the truth about treatments and health. This helps patients trust them and make good decisions about their care.

250 Words Essay on Medical Ethics

Medical ethics is about right and wrong in medicine. It guides doctors, nurses, and other health workers to make good choices for their patients. Imagine being sick and needing someone to trust with your health. That’s where medical ethics comes in. It helps make sure everyone is treated fairly and with respect.

Rules for Doctors

Doctors follow special rules called the Hippocratic Oath. This promise makes them agree to help patients, not harm them, and keep their information private. It’s like a secret promise to take good care of people who are sick.

Keeping Secrets

One big rule in medical ethics is privacy. This means doctors should keep what they know about your health just between you and them. It’s important because it helps you feel safe to tell your doctor everything they need to know to help you.

Choosing Fairly

Sometimes, doctors have to make tough choices, like who gets a new medicine first when there’s not enough for everyone. Medical ethics helps them decide in a way that’s fair and doesn’t pick favorites.

Respecting Choices

Patients have the right to make choices about their own health. Doctors should listen and respect what you want, even if it’s different from what they think is best. It’s like being the boss of your own body.

In conclusion, medical ethics is about making good, fair, and respectful choices in healthcare. It’s a set of rules that help doctors and patients work together to make the best decisions.

500 Words Essay on Medical Ethics

What are medical ethics.

Medical ethics are rules that help doctors and health workers make good choices when they care for patients. These rules are important because they guide professionals to do what is right and fair for everyone. Imagine you’re playing a game. Rules in a game help you understand what you can and cannot do. Similarly, medical ethics are like rules for doctors and nurses, telling them how to do their job well and treat patients kindly.

Respect for Patients

One big rule in medical ethics is to respect patients. This means doctors should listen to what patients want for their health. For example, if a patient doesn’t want to take a certain medicine, the doctor should respect their choice. It is also about keeping secrets. When you tell a doctor something private, they should not tell anyone else. This is called patient confidentiality.

Doing Good and Not Harming

Doctors should always try to help and not hurt their patients. This idea is often said in Latin as “Primum non nocere,” which means “First, do no harm.” It’s like when you’re playing with friends; you want to have fun but not hurt anyone. Doctors must make sure that the treatments they give do not cause more problems than they solve.

Fairness is also a key part of medical ethics. This means that doctors should treat everyone equally. It doesn’t matter who the patient is, where they come from, or how much money they have. Everyone should get the same chance to receive good health care. Think of it like sharing toys; everyone should get a turn.

Telling the Truth

Telling the truth, also known as honesty, is very important in medical ethics. Doctors should always give clear and truthful information to their patients. If a treatment has risks, they should explain those risks. It’s like when a friend asks you if their drawing is good; you should be kind but also tell the truth if there is something they can improve.

Keeping Promises

Doctors should keep their promises. If they say they will do something, like call you with test results, they should do it. This builds trust between doctors and patients. It’s like when you promise to give back a borrowed pencil; your friend trusts you to do what you said.

Improving Themselves and the Profession

Finally, doctors should always try to get better at what they do. They should learn new things and improve their skills. This helps them take better care of their patients. It’s similar to practicing a sport or a musical instrument; the more you practice, the better you get.

In conclusion, medical ethics are a set of rules that help doctors and health workers make the best decisions for their patients. They include respecting patients, doing good, being fair, telling the truth, keeping promises, and always trying to improve. These rules make sure that when you go to a doctor, you are treated with care, honesty, and respect.

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Ethics in the Healthcare Delivery Research Paper

Introduction, basis for healthcare ethics, ethics and abortion, ethics and cloning, reference list.

Ethics forms the basis for healthcare delivery and provision which differ from one discipline to another. This paper focuses on issues which makes ethics formulation troublesome. Contemporary bioethics is based on four major principles; autonomy, justice no-maleficence, and beneficence. The current healthcare delivery relies majorly on autonomy as the most critical factor for ethics establishment.

A recent ethical issue in healthcare concerns the approach of circumstance in which weak individuals are involved such as the unborn and the aged. The society has the obligation of protecting such individuals from oppression through professional and organizational ethic. This paper focuses on the ethics involved in helpless unborn members of a society. Further steps should be taken to ensure that the goals of healthcare delivery and access should be secondary to the welfare of a helpless being involved.

All life challenges have answers, although all answers are not founded on ethical principles. Principles only, do not end in ethical choices, that is, decisions that are not based on principles are ethically irrelevant (Sheikh, 2007). Moral mistakes still persist in different aspects of healthcare. Thus, ethical norms have to be observed in healthcare systems, science and technology, biomedical research, and public health (Beauchamp, & Childress, 2001).

Several key ethical issues accompany healthcare delivery and provision. These issues include concerns for how resources are allocated; who decides who gets what; measurement of outcomes; definition of success; prioritization with regard for cost-effectiveness; population health-being; health inequality or precise methods of health delivery; and special preferences or a more objective perception of best interest (Southern Cross Bioethics Institute, 2008).

Developing ideal guiding standards of healthcare is a challenging task. There are several alternative perspectives. The standards of ‘principlism’ are common in the sense that healthcare delivery is based on four principles including justice, non- maleficence autonomy, and beneficence (Gert, 2004).

Modern worldly bioethics base on autonomy as the superseding value, although many other critics indicate the impracticality and risks in this approach. Specifically, the likely outcomes of the approach of autonomy are the tendency towards a market representation of healthcare structure, a condition that contradicts the conventional principles of medicine (Beauchamp, & Walters, 1999). Besides, it contradicts the facts of life for sufferers of chronic and disabling illnesses, or who are wholly reliant on others for their routine necessities.

Determining who gets what is the core concern for medical ethics. In circumstances of limited healthcare resources, allocation of resources will be based on need, or paying ability, or prospect for profitable productivity, or other certain criteria. The question of who determines patient’s treatment is also important, wherein whether or not the patient’s treatment be decided by the physician or the managers or other relevant persons (Grinnell, 2004, p. 1213).

Also, whether or not every person has the right of access to healthcare services poses a challenge for the policy makers (Hope, 2004). For instance; should criminals or heavy smokers have right to receive transplants even when they are scarce. Moreover, a question whether or not cosmetic surgery should be supported with public funds emerges.

Healthcare as a right for every person implicate that people have unlimited access to it, that healthcare ought to be funded through taxes. Another factor that establishment of healthcare ethics considers whether means-tested healthcare ought to or not be provided. A question of imposing health care insurance and at what define income level, on all healthcare consumers is as well challenging.

The aforementioned ethical questions vary amongst different countries and states in countries, and is a complex process altogether. Noteworthy, the supposition and values underpinning fiscal and management choices should be identified and analyzed.

In the past two decades, bioethics has been defined as the examination and a study of process in which clinical and scientific decisions impact on every individual’s wellbeing and upon different societies and environment.

Bioethics deals with issues concerned with essential human values, including the rights to life and health-being, and the appropriateness or otherwise of specific development in medicine, healthcare organizations, life technological innovations, the health practitioners and society’s accountability for the wellbeing of its members.

Bioethics concerns questions relating to the commencement and ending of human life, ranging from matters associated with in-vitro fertilisation and pregnancy termination to palliative care and euthanasia. Also, the impact of this concept extends to every aspect of human community ranging from the community nursing home to the big international forums on matters such as the Human Genome.

Moreover, bioethics serves as a branch of applied ethics and prerequisite the competence of various professionals such as social science, nursing, the life sciences, medicine, theology, philosophy and law.

Bioethics poses numerous challenging ethical questions for generally all forms of organizations such as families, hospitals, authorities and society. Bioethics is important because essential human values including human life, the integrity of the frail and the aged, unbiased healthcare, bodily integrity and the potential to take decisive actions are at stake. The subsequent paragraphs will focus on how ethics applies to abortion and cloning.

The issue of abortion, the typical bioethics theme, poses in-depth private issues for many people. It is a polarizing and discordant matter that triggers controversies about politics, morals, religion, medicine, autonomy, and sexuality. The core issue is how the unborn children can be perceived, whereby the unborn child is initially termed an embryo and subsequently, fetus (Grinell, 2004).

The definition of their moral status describes their worth in life, and the general public responsibility towards them. In this regard, the issue of personhood emerges, as a theoretical and legal argument concerning the rights to accord them.

The question of everyone’s relationship to the unborn as a member of the human species is controversial. For instance, the question whether or not their lives should be safeguarded, or if their mothers are autonomous concerning choice of killing or protecting their unborn is debatable. The circumstances under which the killing of the unborn is permissible should be defined. In this regard the legal penalties associated with the practice of abortion on woman devoid of her approval, or to induce her to suffer a miscarriage arises.

Although the ethical perspective of abortion is related with its legal perspective, they are distinct. In this regard various questions arise. First, whether or not it is moral and it should be legal. Second, whether or not it should be abolished and should be accorded exceptions. Third, whether it should or not be funded by the public. Fourth, whether it should or not be restricted. Fifth, whether doctors and nurses should or not be granted the power to object based on their principles.

A weaker but significant argument on this issue focuses on the rationale behind a woman’s decision to undertake abortion. The question of whether or not the choice of abortion is free throughout, or women are subject to coercion in any manner is debatable (Cook & Dickens, 1994).

Also, whether or not it is liberal to undertake abortion because of despair arising from poverty, hostility, or lack of sustenance is arguable. In addition, the argument on what should or not be the community and policy reactions to women who are less confident of childbearing arise.

Any debates about cloning must start with a cautious definition. Cloning can naturally occur at different levels including at the DNA level, cellular level, and organism level. Characteristically ethical concern is directed towards cloning in the context of genetic replication of an entire organism (Purtilo, 1999).

Although the cloning of non-mammals has been undertaken in research context for several years, the initial cloning of a mammal, a sheep called Dolly puzzled many in the scientific fraternity. This renaissance was rapidly followed by the cloning of other species and strong belief of the possibility of cloning human beings.

Subsequently, cloned human embryos have been developed although there are no reliable publications that any of these embryos have been implanted into a uterus of a woman and developed to a pregnancy. Cloning to birth is termed reproductive cloning, while the cloning of embryos in order to provide stem cells for prospective research or for therapeutic applications is termed therapeutic cloning.

The major ethical concern with therapeutic cloning arises from the moral status of the cloned embryo, which is developed purposely form destruction. The ethical issues for the reproductive cloning on the other hand, arises from concern include genetic degradation to the clone, health threats to the woman, very minimal success probability implying loss of large amount of fetuses and embryos, psychological adverse effects to the clone, intricate changed familial connection, and co-modification of human existence (Purtilo, 2009).

The responsibility of the healthcare practitioners concerns patient’s protection and fulfillment of legal requirements. It is important that patient’s welfare and human rights should be respected to ensure safe delivery of health care and preservation of life.

Beauchamp, T. L., & Walters, L. (1999). Contemporary Issues in Bioethics. 7th ed. Belmont, CA: Wadsworth Pub.

Beauchamp, T. L., & Childress, J. F. (2001). Principles of Biomedical Ethics . 5 th ed. Oxford, New York: Oxford University Press.

Cook, R. J., & Dickens, B. M. (1994). Ethics, Justice and women’s health. Int J Gynaecol Obstet, 64, 81-5.

Gert, B. (2004). Common Morality: Deciding What to Do. New York, NY: Oxford University Press.

Grinnell, F. (2004). Human embryo research, from moral uncertainity to death . Am J Bioethics, 4:1213.

Hope, T. (2004). Medical Ethics – a very short introduction . Oxford: Oxford University Press.

Purtilo, R. (1999). Ethical Dimensions in the Health Professions . 3rd ed. Philadelphia: WB Saunders.

Purtilo, R. (2009). The ethical life of rural health care professionals . One court street, Lebanon: Tristees of Dartmond college.

Sheikh, S. A. (2007). The Importance of ethics in health care system. JDUHS, 1(1), 46-48.

Southern Cross Bioethics Institute. (2008). Healthcare. Web.

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  • Bioethics: Definition and Application
  • Ethics of Cloning
  • Bioethics Principles in Healthcare
  • Legal Issues Related to Frozen Embryos
  • Whether or not Human Cloning Should be Allowed
  • Human Dignity and Bioethics
  • Human Cloning as an Ethical Issue
  • Concept of Bioethics in Society
  • Controversies in Therapeutic Cloning
  • Jonathan Moreno: Bioethics After the Terror
  • The Major Components of Bioethics in Healthcare
  • Ethical and Legal Issues in Nursing Setting
  • No More Abortion: Anti-abortion Debate
  • Why Physician-Assisted Death on the Terminally Ill lacks Justification
  • Physician-Assisted Suicide

Sample details

Health Care

  • Universal Health Care
  • Words: 1858

Related Topics

  • Informed consent

Health Care Ethics

The meaning of health is often disputed. Different people and cultures have different understanding of what it means to be healthy, whether health is simply a medical state, or a broader, more holistic state. I believe that health is much more than its medical definition, that is, being free of disease. Although this is certainly a component of health, the meaning of health goes beyond this to include a broader, open-ended approach centered around different aspects of health.

Throughout time, many have given their take on the definition of health. According to the Cambridge Dictionary, health is “the condition of the body and the degree to which it is free from illness, or the state of being well.”[Cambridge University Press, 2019] In 1948, the World Health Organization (WHO) adopted a definition of health which says health is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”[World Health Organization, 2019, para. 1] Importantly, this acknowledges other factors important to overall health and is considerably broader. However, this definition seems to set the bar too high. The absoluteness of the word “complete” seems very unattainable, if not impossible. This would therefore imply that no one can be healthy, which obviously should not be the case. To be healthy, one does not need to perfect socially, mentally, and physically. In my opinion, one can be classified as and live a healthy life without being perfect in these three aspects of health. A third definition to consider can be seen in the Ottawa Charter for Health Promotion, an important Health Canada document. It states that to be healthy, “an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment.” [Government of Canada, 2019, para. 3] This is also considerably open-ended and may classify some as wrongfully unhealthy. Taken together, I believe we must stand somewhere in the middle of these two ends of the spectrum. That is, all three descriptions of health are relevant, but I do not believe they are true on their own.

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Health is inevitably tied to many determinants. This includes social, mental, and physical, as stated by the WHO. But more specifically, we can also include economic, environmental, ecological, and personal factors as important. In the 21st century, these factors are constantly changing around us. Rapid changes occur throughout society every day. As human beings, we are constantly adapting to this change in numerous ways. We are responsible for our health to an extent, and the factors around us also play a role in shaping our health. Thus, a key component of the meaning of health must be one’s ability to adapt. At the same time, the WHO definition, as well as the Cambridge Dictionary definition and Ottawa Charter interpretation must be included to some extent.

Therefore, I believe that health means being able to adapt in order to live in an ideal state of physical, social, and mental well-being. In this situation, ideal can be defined by oneself, as well as a doctor and society at large. This definition allows for many essential determinants of health to be included, such as social, environmental, physical, and mental well-being. Due to the ever-changing society and individual differences, the ideal state can be combination of one’s own conception, as well as doctor’s, and the general public. In this way, health is more dynamic, allowing for the definition to be tailored to the individual. Yet, it is still rigid enough that one can decisively distinguish between healthy, and unhealthy.Each moral theory has major defining factors. There is no single correct or best theory; each may be favored in different situations. In order to make decisions about the applicability of each theory, it is important to understand the basic features of each.

Utilitarianism is a monistic, consequentialist theory. Its central idea is that the morality of an action should be determined based on the principle of utility. Whether or not an action is considered moral depends solely on the consequences of the action. Should the consequences promote utility (happiness) for those affected by the action, it would be considered moral. Anything which would produce a greater amount of happiness or decrease the amount of unhappiness would be considered moral. Other factors are not important to the decision and should be rejected. Furthermore, utilitarianism says that each person should only be valued as one person; that is, all people should be valued as equals. In addition, utilitarianism is further divided into act utilitarianism (AU) and rule utilitarianism (RU). The difference between AU and RU lies in the fact that AU focuses on individual actions, while RU focuses on the effects of types of actions. Specifically, in AU, individual actions are judged based on maximizing utility. Conversely, in RU, actions are judged based on the consequences if it were to become a general rule for all of society. According to RU, an act would be morally correct if it agrees with a universal general rule which tends to maximize happiness or minimize unhappiness.

Kant’s deontological ethics is a duty-based, monistic theory. It is a non-consequentialist theory due to the fact that it is deontological (duty-based). Actions are judged based on whether they are performed for the sake of moral duty. Thus, all actions are either required by moral duty, forbidden by moral duty, or simply permissible (amoral). Kant’s two leading formulations help one to understand what actions fall into each category. The first formulation describes that one should always act upon a principle which could be a universal law for all rational beings to follow. The second formulation details that one should act so that humanity is always treated as an end, but never as only a means. Taken together, the two formulations show that actions which treat beings solely as a means, and/or cannot be considered a universal law are forbidden. Actions which treat beings with respect and dignity are required by Kant’s formulations. Finally, actions which are neither moral, nor immoral, are simply permissible.

Aristotelian virtue ethics is a goal-oriented theory, which argues that we should be virtuous people. According to Aristotle, there is but one goal in life, which is happiness and well-being. A virtuous human can achieve this state by being able to make morally acceptable decisions. Virtues are qualities of character, which are learned through experience and considerable practice. Virtue is a kind of disposition which is centered around living in moderation, courageously, and generously; in harmony with thought and feeling. Aristotle argues that decisions cannot be made solely based on moral rules and obligations, but requires unity of virtuous qualities and character traits to make morally valid decisions. In this way, a virtuous human can choose the best option between two extremes. There may be other goals in life, however, these are merely intermediate ends to the final goal of happiness and well-being.

Feminist ethics is a theory which has been developed over time as a challenge to traditional theories which are considerably more individualistic and largely developed my males. It argues that traditional theories fail to consider the moral experience of females, and are inherently built into the foundations of society, fostering bias and discrimination. It aims to understand and correct this. An integral part of feminist ethics is context, which is not included to the same extent in traditional theories. That is, when making decision about moral issues, the context of the situation should be considered. This often includes the socio-political context. Therefore, whether actions, situations, and societies are just is also an important factor in making moral decisions. The modified-egalitarian and libertarian resource allocation models differ in many ways. This includes their basic characteristics and values, as well as how these characteristics affect society. Both models can be applied as health care systems. In this way, the advantages and disadvantages of both models can be seen. The libertarian health care system model focuses on individual freedoms. In this system, health care is a commodity, much like other consumer goods and services. It can be sold and purchased; the free market will determine the supply and demand. This can be contrasted with a modified-egalitarian system, which focuses on freedom as well as equality. In this model, typically a basic universal health care will be offered, with other non-basic services and goods offered at a price. The basic health care will be guaranteed to all, and financed as a public service. Therefore, there is an aspect of equality from the basic health care offered, but also freedom to purchase goods and services which are not considered basic. I believe that the advantages of the modified-egalitarian model outway its disadvantages.

Comparing the two models, there are clear advantages of the modified-egalitarian model over the libertarian model. The major advantage of the modified-egalitarian model is that everyone is guaranteed basic health care. That is, everyone has equal right to the basic health care. This is different that the libertarian model where there is no guaranteed health care. A second important advantage is the decreased bureaucracy in the modified-egalitarian model. In the libertarian model, health care is commodity, much like other consumer goods and services. In the modified-egalitarian model, it is viewed as more of a basic right. As a result, the libertarian model makes way for increased profits of sellers, and therefore typically has increased bureaucracy compared to the modified-egalitarian model. This is an important advantage of the modified-egalitarian system as it allows for less steps between physicians treating patients and payment for their services.

Conversely, the modified-egalitarian has multiple disadvantages when contrasted with the libertarian model. Firstly, due to the lack of a free market (and therefore competition and supply and demand), there is no market regulating prices. As a result of this, there is little to no incentive for cost containment. A second major disadvantage to the modified-egalitarian model is that it may have decreased efficiency, compared to the libertarian model. This includes extensive wait times and more inefficient resource allocation. As a result of the perceived free service, demand and spending increases both continually increase.

In my opinion, the advantages of the modified-egalitarian model outweigh its disadvantages. According to the World Health Organization (WHO), health is a fundamental human right, and they support countries in moving towards universal health care. This is something which I agree with, and the modified-egalitarian model supports having basic universal health care available to all. In this sense, health is a right, rather than a commodity. As well, the decreased bureaucracy and increased professional autonomy of the modified-egalitarian system allows for decreased steps between the patient and the physician. While efficiency and cost containment are no doubt integral components of a successful health care system, they can still be achieved within reason. A prime example of this is the Canadian health care system. The Canadian system has its downfalls, however, it still manages to provide universal health care to all at a smaller cost that the American system, which has libertarian roots. Overall, I believe that the advantages of the modified-egalitarian system outweigh its disadvantages.

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40 facts about elektrostal.

Lanette Mayes

Lanette Mayes

Modified & Updated: 04 Feb 2024

Published: 22 Jul 2023

Modified: 04 Feb 2024

40-facts-about-elektrostal

Elektrostal is a vibrant city located in the Moscow Oblast region of Russia. With a rich history, stunning architecture, and a thriving community, Elektrostal is a city that has much to offer. Whether you are a history buff, nature enthusiast, or simply curious about different cultures, Elektrostal is sure to captivate you.

This article will provide you with 40 fascinating facts about Elektrostal, giving you a better understanding of why this city is worth exploring. From its origins as an industrial hub to its modern-day charm, we will delve into the various aspects that make Elektrostal a unique and must-visit destination.

So, join us as we uncover the hidden treasures of Elektrostal and discover what makes this city a true gem in the heart of Russia.

Known as the “Motor City of Russia.”

Elektrostal, a city located in the Moscow Oblast region of Russia, earned the nickname “Motor City” due to its significant involvement in the automotive industry.

Home to the Elektrostal Metallurgical Plant.

Elektrostal is renowned for its metallurgical plant, which has been producing high-quality steel and alloys since its establishment in 1916.

Boasts a rich industrial heritage.

Elektrostal has a long history of industrial development, contributing to the growth and progress of the region.

Founded in 1916.

The city of Elektrostal was founded in 1916 as a result of the construction of the Elektrostal Metallurgical Plant.

Located approximately 50 kilometers east of Moscow.

Elektrostal is situated in close proximity to the Russian capital, making it easily accessible for both residents and visitors.

Known for its vibrant cultural scene.

Elektrostal is home to several cultural institutions, including museums, theaters, and art galleries that showcase the city’s rich artistic heritage.

A popular destination for nature lovers.

Surrounded by picturesque landscapes and forests, Elektrostal offers ample opportunities for outdoor activities such as hiking, camping, and birdwatching.

Hosts the annual Elektrostal City Day celebrations.

Every year, Elektrostal organizes festive events and activities to celebrate its founding, bringing together residents and visitors in a spirit of unity and joy.

Has a population of approximately 160,000 people.

Elektrostal is home to a diverse and vibrant community of around 160,000 residents, contributing to its dynamic atmosphere.

Boasts excellent education facilities.

The city is known for its well-established educational institutions, providing quality education to students of all ages.

A center for scientific research and innovation.

Elektrostal serves as an important hub for scientific research, particularly in the fields of metallurgy, materials science, and engineering.

Surrounded by picturesque lakes.

The city is blessed with numerous beautiful lakes, offering scenic views and recreational opportunities for locals and visitors alike.

Well-connected transportation system.

Elektrostal benefits from an efficient transportation network, including highways, railways, and public transportation options, ensuring convenient travel within and beyond the city.

Famous for its traditional Russian cuisine.

Food enthusiasts can indulge in authentic Russian dishes at numerous restaurants and cafes scattered throughout Elektrostal.

Home to notable architectural landmarks.

Elektrostal boasts impressive architecture, including the Church of the Transfiguration of the Lord and the Elektrostal Palace of Culture.

Offers a wide range of recreational facilities.

Residents and visitors can enjoy various recreational activities, such as sports complexes, swimming pools, and fitness centers, enhancing the overall quality of life.

Provides a high standard of healthcare.

Elektrostal is equipped with modern medical facilities, ensuring residents have access to quality healthcare services.

Home to the Elektrostal History Museum.

The Elektrostal History Museum showcases the city’s fascinating past through exhibitions and displays.

A hub for sports enthusiasts.

Elektrostal is passionate about sports, with numerous stadiums, arenas, and sports clubs offering opportunities for athletes and spectators.

Celebrates diverse cultural festivals.

Throughout the year, Elektrostal hosts a variety of cultural festivals, celebrating different ethnicities, traditions, and art forms.

Electric power played a significant role in its early development.

Elektrostal owes its name and initial growth to the establishment of electric power stations and the utilization of electricity in the industrial sector.

Boasts a thriving economy.

The city’s strong industrial base, coupled with its strategic location near Moscow, has contributed to Elektrostal’s prosperous economic status.

Houses the Elektrostal Drama Theater.

The Elektrostal Drama Theater is a cultural centerpiece, attracting theater enthusiasts from far and wide.

Popular destination for winter sports.

Elektrostal’s proximity to ski resorts and winter sport facilities makes it a favorite destination for skiing, snowboarding, and other winter activities.

Promotes environmental sustainability.

Elektrostal prioritizes environmental protection and sustainability, implementing initiatives to reduce pollution and preserve natural resources.

Home to renowned educational institutions.

Elektrostal is known for its prestigious schools and universities, offering a wide range of academic programs to students.

Committed to cultural preservation.

The city values its cultural heritage and takes active steps to preserve and promote traditional customs, crafts, and arts.

Hosts an annual International Film Festival.

The Elektrostal International Film Festival attracts filmmakers and cinema enthusiasts from around the world, showcasing a diverse range of films.

Encourages entrepreneurship and innovation.

Elektrostal supports aspiring entrepreneurs and fosters a culture of innovation, providing opportunities for startups and business development.

Offers a range of housing options.

Elektrostal provides diverse housing options, including apartments, houses, and residential complexes, catering to different lifestyles and budgets.

Home to notable sports teams.

Elektrostal is proud of its sports legacy, with several successful sports teams competing at regional and national levels.

Boasts a vibrant nightlife scene.

Residents and visitors can enjoy a lively nightlife in Elektrostal, with numerous bars, clubs, and entertainment venues.

Promotes cultural exchange and international relations.

Elektrostal actively engages in international partnerships, cultural exchanges, and diplomatic collaborations to foster global connections.

Surrounded by beautiful nature reserves.

Nearby nature reserves, such as the Barybino Forest and Luchinskoye Lake, offer opportunities for nature enthusiasts to explore and appreciate the region’s biodiversity.

Commemorates historical events.

The city pays tribute to significant historical events through memorials, monuments, and exhibitions, ensuring the preservation of collective memory.

Promotes sports and youth development.

Elektrostal invests in sports infrastructure and programs to encourage youth participation, health, and physical fitness.

Hosts annual cultural and artistic festivals.

Throughout the year, Elektrostal celebrates its cultural diversity through festivals dedicated to music, dance, art, and theater.

Provides a picturesque landscape for photography enthusiasts.

The city’s scenic beauty, architectural landmarks, and natural surroundings make it a paradise for photographers.

Connects to Moscow via a direct train line.

The convenient train connection between Elektrostal and Moscow makes commuting between the two cities effortless.

A city with a bright future.

Elektrostal continues to grow and develop, aiming to become a model city in terms of infrastructure, sustainability, and quality of life for its residents.

In conclusion, Elektrostal is a fascinating city with a rich history and a vibrant present. From its origins as a center of steel production to its modern-day status as a hub for education and industry, Elektrostal has plenty to offer both residents and visitors. With its beautiful parks, cultural attractions, and proximity to Moscow, there is no shortage of things to see and do in this dynamic city. Whether you’re interested in exploring its historical landmarks, enjoying outdoor activities, or immersing yourself in the local culture, Elektrostal has something for everyone. So, next time you find yourself in the Moscow region, don’t miss the opportunity to discover the hidden gems of Elektrostal.

Q: What is the population of Elektrostal?

A: As of the latest data, the population of Elektrostal is approximately XXXX.

Q: How far is Elektrostal from Moscow?

A: Elektrostal is located approximately XX kilometers away from Moscow.

Q: Are there any famous landmarks in Elektrostal?

A: Yes, Elektrostal is home to several notable landmarks, including XXXX and XXXX.

Q: What industries are prominent in Elektrostal?

A: Elektrostal is known for its steel production industry and is also a center for engineering and manufacturing.

Q: Are there any universities or educational institutions in Elektrostal?

A: Yes, Elektrostal is home to XXXX University and several other educational institutions.

Q: What are some popular outdoor activities in Elektrostal?

A: Elektrostal offers several outdoor activities, such as hiking, cycling, and picnicking in its beautiful parks.

Q: Is Elektrostal well-connected in terms of transportation?

A: Yes, Elektrostal has good transportation links, including trains and buses, making it easily accessible from nearby cities.

Q: Are there any annual events or festivals in Elektrostal?

A: Yes, Elektrostal hosts various events and festivals throughout the year, including XXXX and XXXX.

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19th Edition of Global Conference on Catalysis, Chemical Engineering & Technology

Victor Mukhin

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Victor Mukhin, Speaker at Chemical Engineering Conferences

Title : Active carbons as nanoporous materials for solving of environmental problems

However, up to now, the main carriers of catalytic additives have been mineral sorbents: silica gels, alumogels. This is obviously due to the fact that they consist of pure homogeneous components SiO2 and Al2O3, respectively. It is generally known that impurities, especially the ash elements, are catalytic poisons that reduce the effectiveness of the catalyst. Therefore, carbon sorbents with 5-15% by weight of ash elements in their composition are not used in the above mentioned technologies. However, in such an important field as a gas-mask technique, carbon sorbents (active carbons) are carriers of catalytic additives, providing effective protection of a person against any types of potent poisonous substances (PPS). In ESPE “JSC "Neorganika" there has been developed the technology of unique ashless spherical carbon carrier-catalysts by the method of liquid forming of furfural copolymers with subsequent gas-vapor activation, brand PAC. Active carbons PAC have 100% qualitative characteristics of the three main properties of carbon sorbents: strength - 100%, the proportion of sorbing pores in the pore space – 100%, purity - 100% (ash content is close to zero). A particularly outstanding feature of active PAC carbons is their uniquely high mechanical compressive strength of 740 ± 40 MPa, which is 3-7 times larger than that of  such materials as granite, quartzite, electric coal, and is comparable to the value for cast iron - 400-1000 MPa. This allows the PAC to operate under severe conditions in moving and fluidized beds.  Obviously, it is time to actively develop catalysts based on PAC sorbents for oil refining, petrochemicals, gas processing and various technologies of organic synthesis.

Victor M. Mukhin was born in 1946 in the town of Orsk, Russia. In 1970 he graduated the Technological Institute in Leningrad. Victor M. Mukhin was directed to work to the scientific-industrial organization "Neorganika" (Elektrostal, Moscow region) where he is working during 47 years, at present as the head of the laboratory of carbon sorbents.     Victor M. Mukhin defended a Ph. D. thesis and a doctoral thesis at the Mendeleev University of Chemical Technology of Russia (in 1979 and 1997 accordingly). Professor of Mendeleev University of Chemical Technology of Russia. Scientific interests: production, investigation and application of active carbons, technological and ecological carbon-adsorptive processes, environmental protection, production of ecologically clean food.   

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While most of NCCIH’s research support goes to U.S. institutions, we do in some instances support work outside of the United States which is in alignment with our strategic plan and research priorities .

Most work in other countries is supported through subcontracts or consortium agreements of U.S. grantees.

Direct funding of research at foreign institutions is possible under a limited set of grant mechanisms or specifically targeted initiatives. Investigators from non-U.S. institutions interested in direct funding of their research by NCCIH should contact the appropriate NCCIH Program Director to discuss eligibility and opportunities.

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NCCIH will not consider applications involving interventional clinical trials outside of the United States and Canada.

Foreign institutions are eligible for funding through direct mechanisms (R01, R21, and R03) only when specified in the PA or RFA. In addition, NCCIH encourages foreign researchers to contact the appropriate NCCIH Program Director noted in the PA or RFA, or on the NCCIH website.

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Foreign institutions often receive NIH/NCCIH support as foreign components of a grant made to another research institution. In these cases, the funding flows from the grantee institution to the foreign collaborating institution through a subcontract agreement between the two institutions. The subcontract agreement details the respective roles, activities and responsibilities of both institutions, and any conditions or terms for payment of subcontract funds. These arrangements are developed during the grant application process.

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All research proposals submitted to NIH undergo the same process of scientific peer review .

In addition, NIH policy requires that specific criterion be considered in the review process and award decision for foreign grant applicants, including whether the project presents special opportunities for furthering research programs through the use of unusual talent, resources, populations or environmental conditions in other countries that are not readily accessible in the United States, or that augment existing U.S. resources, and whether the proposed project has the potential for significantly advancing the health sciences.

Policy requires that all proposed projects must have specific relevance to the mission and objectives of NCCIH and also stipulates that all foreign grant applications be specifically reviewed and recommended for funding by NCCIH’s National Advisory Council .

Clearance by the U.S. Department of State may also be required, and there may be special requirements of the government of the foreign country in which the research will take place.

NIH Fogarty International Opportunities for Foreign Scientists

The Fogarty International Center is dedicated to advancing the mission of NIH by supporting and facilitating global health research conducted by U.S. and international investigators, building partnerships between health research institutions in the United States and abroad, and training the next generation of scientists to address global health needs. Information on specific opportunities can be found at fic.nih.gov .

For questions about the research project:

Please contact the Program Director who can discuss the scientific area of your research.

For general inquiries about international health research:

Please contact the NCCIH Division of Extramural Research at [email protected] .

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Conducting research in an international setting poses unique challenges. The information below provides guidance to Penn students, trainees, and faculty designing and implementing research in foreign countries. For more information on IRB submission, please contact the Penn IRB .

Penn students, trainees, and faculty conducting research on human subjects in foreign countries must obtain IRB approval from the Penn IRB prior to beginning any research activities at an international site. As additional review and documentation may be needed, the application timeline can be lengthy. It is advised to start the process early (6+ months before anticipated start date) and expect delays.

Submission to the Penn IRB and Determination of Human Subjects Research

Refer to the Penn IRB tools under the heading ‘Human Research – Is IRB Review Required?’ to determine if the study qualifies as human subjects research. If the study meets the regulatory definition of human research, IRB approval must be received before conducting any research. Submission guidance is available online here . If a study is determined to be human subjects research requiring IRB review, publication of the research is contingent on IRB approval. 

Submission to an International Ethics Committee (EC) or Ministry of Health

Investigators must consider local cultural and religious norms when designing an international research study as well as any special conditions of the population being targeted for recruitment.  Therefore, partnering with a local collaborator is highly recommended by the Penn IRB. Research studies must be reviewed by a local Ethics Committee or Ministry of Health. All CGH supported projects require engagement with a partner institution, however. If one is unable to obtain local ethics committee review, contact the Penn IRB to discuss other options.

Submission to a local institution should precede or be concurrent with the submission to the Penn IRB. Note that processing time for human subjects research approval can vary widely from country to country. In order to plan your research timeline, you should seek advice about this timeframe from your in-country collaborator.

The US Office of Human Research Protections compiles a listing of research standards in 130+ countries. This document enumerates country-level laws, regulations, and guidelines that govern human subject protections.  Investigators must comply with both US and foreign regulations.

Guidance for Penn FacultY

In rare circumstances, faculty members conducting research outside of their Penn responsibilities, such as with NGOs, should appropriately represent that work through either the Penn IRB or the NGO’s IRB.  Penn IRB approval or a Data Use Agreement may be needed if the research will continue at Penn. For more information on what constitutes engagement in human subjects research, please refer to the Office for Human Research Protections’ guide . If questions remain regarding your role, please contact the Penn IRB.

Guidance for Penn students and trainees

To determine if submission to the Penn or local IRB is needed, please consult with the study’s Principal Investigator (PI) and review the information above. If you would like to discuss way to engage in research in order to fulfill a requirement (e.g. capstone), reach or out CGH staff or your advisor to discuss opportunities and timing.

 Training in Human Subjects Research curriculum ( CITI Training ) is required for anyone engaged in human subjects research at Penn. More information on these requirements can be found on the Penn IRB website.

In order for a student or trainee to carry out certain research procedures on a pre-existing non-exempt study, a study modification should be submitted to the Penn IRB and the local ethics committee. The study modification must be approved before new study personnel begins any study involvement including consenting, conducting research procedures and/or interacting with participants, and/or having access to identifiable data/specimens. Guidance is available for how and when to submit modifications to the Penn IRB .

Penn students and trainees working with a PI at another institution (US or international) do not need to seek IRB approval from the Penn IRB but should be added to the study by the PI at the other institution. Contact the primary institution to be added to the study.

Data Security

A Data Use Agreement (DUA) or Business Associates Agreement (BAA) may be needed if Protected Health Information (PHI) is transferred. Please contact Penn’s Office of Research Support Services for more information.

Export Control

Export control laws (ECLs) are federal regulations that govern how information, technologies, and commodities can be transmitted to anyone internationally, including U.S. citizens, or to foreign nationals in the United States, and prohibit the unlicensed export of certain items and services. Generally, most academic international collaborations, shipments, and/or travel will not require a license; however, a license determination depends on several factors. The  Export Compliance Office  in the Office of Research Services can help make this determination.

Other Resources

  • US Department of Health and Human Services: Office of Human Research Protections
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  • Managing International Collaborations
  • CUGH Webinar: Establishing a Career in Global Health Research

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The primary goal of the International Healthcare Research Center (IHRC) is to promote transparency and improve global healthcare quality, population health management, expanded access to care, and the consumer healthcare experience.

The International Healthcare Research Center is a 501c (3) non-profit research center, dedicated to conducting research and delivering reliable information and actionable strategic insight in the following areas:

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Professor Christopher Davis

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Christopher Mark Davis became a Professorial Research Fellow at OIPA in October 2016. His most recent article on ageing (2016) is entitled The Changing Capabilities of Cohorts of the Elderly in Russia During 1990-2020: Measurement Using a Quantitative Index (now under review by a journal).  This examined the life experiences and characteristics at the age of 60 of the Russia births cohorts of 1930, 1935, 1940, 1950 and 1960. His initial new research for OIPA will make use of a similar quantitative methodology to carry out an international comparison of the changing capabilities of cohorts of the elderly during 1990-2010 in seven countries that have experienced major wars and economic crises since 1930: China, Germany, Japan, Russia, South Korea, UK and USA. Professor Davis has been an academic at Oxford University for 25 years and has held the post of Reader in Command and Transition Economies in the Department of Economics and School of Interdisciplinary Area Studies (Russian and East European Studies). Since 2013 he has been involved in two health-related research projects (also covering ageing topics) in Russia in the following positions: Head of the Research Laboratory on the Economics of Health and Health Reform at the Russian Presidential Academy of the National Economy and Public Administration in Moscow and International Research Fellow in the Centre of Health Economics, Management and Policy (CHEMP) at the Higher School of Economics St. Petersburg .

Christopher received his B.A. ( Applied Mathematics ) from Harvard College in 1969, served as an officer in the U.S. Navy during 1969-73 and was a postgraduate student in the Economics Faculty of Cambridge University during 1973-78 (with one year spent at Moscow State University). He wrote a doctoral thesis on The Economics of Health in the USSR (Ph.D. in Economics 1980) that evaluated health issues empirically using a quantitative model linking the population, health sector and economy in the USSR, which was based on a methodology developed by his Ph.D. Supervisor, Professor Richard Stone ( Nobel Prize 1984 ). Christopher was one of the first scholars in the world to analyse the problem of rising mortality in the USSR. From 1978 to 1991 Christopher was the Lecturer in Soviet Social Policy at the Centre for Russian and East European Studies at the University of Birmingham. He taught a course there that covered issues related to population ageing and the welfare of the elderly in the USSR. At Oxford Christopher also has worked on the topics of industry and defence economics in the USSR and Russia. His most recent publication (2016) presents a defence economic analysis of the Ukraine conflict (Open Access)

Links to publicly accessible reports; academic publications available on request.

  • Priorities, Shortages, and Rationing in the UK and Russia National Health Services during 2000–2019: Initial Conditions for Responses to Covid-19.
  • The Changing Capabilities of Cohorts of the Elderly in Russia during 1990–2020: Measurement using a Quantitative Index
  • Russia’s Changing Economic and Military Relations with Europe and Asia from Cold War to the Ukraine Conflict: The Impacts of Power Balances, Partnerships, and Economic Warfare
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Article Contents

Infrastructure needs, creating dynamic, equitable governance, building international collaboration and capabilities, a path to the future.

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Achieving the promise of artificial intelligence in health and medicine: Building a foundation for the future

Competing Interest: V.J.D. is the president of the National Academy of Medicine.

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Victor J Dzau, Melissa H Laitner, Alex Temple, Tho H Nguyen, Achieving the promise of artificial intelligence in health and medicine: Building a foundation for the future, PNAS Nexus , Volume 2, Issue 12, December 2023, pgad410, https://doi.org/10.1093/pnasnexus/pgad410

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The biomedical research and healthcare delivery ecosystems—both nationally and internationally—are poised to be revolutionized by the continued development of artificial intelligence and machine learning (AI/ML). Comprehensive integration of AI/ML in our healthcare system holds the promise of enhancing operational efficiency and reducing costs, improving diagnostic ability, uncovering new therapeutic targets, and enabling increasingly personalized treatment. The future will be defined by leveraging data for value and efficiency via AI/ML in health research and care delivery.

As Monica Bertagnolli, newly confirmed director of the National Institutes of Health, points out in this issue of PNAS Nexus ( 1 )—“While the potential for AI/ML applications to improve human health research is vast, there are key challenges that must be overcome in order to optimize the outcome for the patient.” At the federal level, there is increasing recognition of the need to ensure AI/ML implementation is responsible, ethical, and equitable, maximizing benefits while minimizing the potential for harm to society. President Biden's recent Executive Order on the Safe, Secure, and Trustworthy Development and Use of Artificial Intelligence ( 2 ) establishes first-of-its-kind standards in the United States for safety, privacy, and civil rights, while still emphasizing the need for scientific innovation and advancement. As Bertagnolli rightfully points out, a multidisciplinary perspective is required to achieve these important goals—one that is inclusive of not only researchers and clinicians but also patients and community organizations, social scientists and equity researchers, and policy and legal experts.

Indeed, equity must be baked into the innovation life cycle. AI/ML faces significant challenges in this regard ( 3 ). Already, the AI/ML workforce does not reflect the socioeconomic composition of the general US or global population. Innovation in these fields is centered within a small subset of highly metropolitan cities along the US coasts, and it is well-known that biases baked into datasets have the potential to create unintentionally discriminatory algorithms. Post-approval, application inequities can exacerbate digital divides, worsen treatment gaps, and negatively influence healthcare decision-making. Potential for irresponsible—or more concerningly, malicious—use is high, which is why the US federal government and other key scientific stakeholders, including the National Academies of Science, Engineering, and Medicine (NASEM), are working to develop oversight and monitoring frameworks capable of addressing these concerns and preventing future harms.

Still, there is more for the scientific community to do if we truly hope to harness the potential of AI/ML. Currently, private industry is setting the pace for AI integration across society, as well as within biomedical research and healthcare delivery. In large part, this is because the barrier to entry for large-scale AI/ML capabilities is extraordinarily high. The federal government incentivizes the private sector to support the national growth of AI research, but across the country, most US universities and healthcare systems are poorly equipped to support the growth of AI research. The Biden administration is actively working with the private sector and philanthropic organizations to coordinate investments, but we must continue to look toward the future of AI/ML in health and research with a critical lens. Coordination with these sectors must employ a mission-driven approach—one that prioritizes social good—and not be conducted solely through a profit-oriented, market-driven framework.

Are we prepared to responsibly harness the power of AI, maximize its benefits, and support a diverse and well-trained AI/ML workforce in the United States? The answer, as it stands, is no—or at least, not yet. As the nation's trusted advisors in science, engineering, and medicine, the National Academies have a key role to play in helping our nation build a bridge to the future through convening key stakeholders, enabling cross-sectoral discussions, and providing evidence-based recommendations.

Recently, the National Academies hosted multiple events on AI as a tool to support research and healthcare, including workshops on AI for Scientific Discovery ( 4 ) and Generative AI & Large Language Models in Health & Medicine ( 5 ). It was inspiring and motivating to see scientists from across fields come together to explore the future of AI and what it might, one day, be capable of achieving. However, these discussions also brought to light major barriers: infrastructure gaps; the need for dynamic, equitable governance; and unmet opportunities for international scientific and policy collaboration.

Biomedical pursuits must benefit all, not just the select few, and advances in AI provide an unprecedented opportunity for personalized and precision medicine. Therefore, in biomedical science with precision medicine, infrastructures are needed to democratize access to both research and outcomes. Simply put, AI is a high-performance computing (HPC) application. As such, making progress in AI discoveries requires commitment to capable, well managed, and accessible computing infrastructure and resources. New infrastructures are needed for data, computation, health, and scaling impact.

Infrastructure for data

Data underpin scientific research and are even more critical to AI development. For research outcomes to equitably benefit all, the data must reflect equity at the front end. The infrastructure must ensure the collection, curation, and management of data that reflect all communities and populations. Toward this goal, the infrastructure must be able to access, and be accessible by, diverse data sources and contributors. We must enable contributions from biomedical labs in Africa as well as community health organizations in rural America. Innovative data collection tools must be integrated to ensure data quality from the moment they are collected, and context-aware algorithms must be deployed such that datasets are visible to researchers. Most importantly, AI data infrastructure must guarantee rights and privacy for individuals and communities. AI models can consume, integrate, and assemble data at orders of magnitude more than previously possible. Consequently, the risk to privacy, security, and ownership for data has also proportionately grown. There are already promising new privacy-preserving techniques that can be integrated, and more must be developed to protect rights and privacy.

Infrastructure for computation

While new computation infrastructures for AI are emerging at a dizzying rate, a new investment is still needed for a public-interest research infrastructure for AI in medicine. As stated earlier, investing in AI computational infrastructure is largely out of reach for individual academic and community research groups; therefore, accessibility must be the number one priority for new infrastructure investments. To enable access for researchers at the long tail of science, supporting tools such as interfaces and workflows, as well as tailored training material, must also be developed concomitantly. Concurrently, we must guard against bad actors looking to take advantage of new AI capabilities in biomedicine. This concern was poignantly described in President Biden's recent executive order ( 2 ).

Infrastructure for health

To fully enable AI in health and healthcare, we must consider the realities of current health systems’ infrastructure. The last decade has seen massive growth in the availability of health data. However, patient records data continue to be siloed within individual electronic records systems. Moreover, these data remain largely disconnected from clinical and research data, public health data, social and community data, and large-scale national datasets. To achieve the goals of precision medicine and precision public health, we need fully integrated datasets with interoperability across settings that are capable of combining multiple types of data to conduct analyses from the cellular level through the population and global health levels. This will require major regulatory efforts to address issues of data sharing and diverse ownership, as well as significant funding to build such data sharing systems at scale. However, the possibilities are immense. In Scotland, primary care records are linked to out-of-hours, emergency care, and secondary care data; laboratory testing records; and national datasets, including registration and mortality records—all through the use of a unique patient identifier. These massive data linkages were analyzed during the pandemic using the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II) database to create the first national scale healthcare surveillance program, allowing near real-time analysis of the COVID-19 pandemic, as well as infection patterns, healthcare use trends, and vaccine and treatment insights ( 6 ).

Infrastructure to scale impact

Scientific research is at its best when outcomes are scaled to benefit communities and populations globally. To achieve this meaningful goal, attendant concerns on quality assurance and workforce must be addressed. On quality assurance, the opacity of AI models makes it challenging to ascertain model performance guarantees—i.e. quality. To ameliorate this issue, AI models released to the public must disclose both the model design as well as the data used in training them. From knowing about the AI model and its training, users can make informed decisions on its capabilities and limitations. And finally, a professional workforce is needed to properly leverage new AI-enabled capabilities in medicine. This new workforce can work in conjunction with physicians and care providers to bring these capabilities to practice.

Overall, there needs to be serious commitment to rethink policies and invest in new infrastructure to enable AI for medicine. Key priorities for the new commitment are accessibility, equity, and rights-preserving. Furthermore, to scale for maximum impact while minimizing risks, the investment in AI in medicine must be a global collaboration. Communities and organizations worldwide can contribute data and knowledge to the new enterprise while helping to safeguard against malicious use.

The rapid emergence of highly capable AI models coupled with the ubiquity of smart technologies are lowering the barrier of access to AI's powerful capabilities across the globe. Yet there exists no comprehensive governance structure overseeing the use of AI/ML at a national or international level, although the US Office of Science and Technology Policy's Blueprint for an AI Bill of Rights ( 7 ) and the recent White House executive order offer initial steps for a framework. At the National Academy of Medicine (NAM), we are currently working to create a comprehensive AI Code of Conduct for Healthcare to provide a framework for ethical use of AI within the health sector.

However, the nature of AI—and many other new and evolving scientific technologies—ensures it permeates across many facets of society, diffuses across previously stable boundaries, and is difficult to assign to one singular lane when it comes to research, regulation, or marketing. As such, there is no singular piece of policy that will “solve” both the current challenges and be capable of capturing and preventing future problems. Therein lies the challenge of the Collingridge dilemma: Early in technological development, it is difficult to predict impact, which creates barriers to building thorough policy for governance. However, during late-stage development and in the post-approval phase, policymaking may be too late to identify and mitigate unintentional harms ( 8 ).

To ensure equity, prevent unintended consequences, and maximize AI's impact and achievements, governance must instead be iterative and dynamic, capable of capturing the broad view of development and evolution of AI across sectors and across all facets of health and medicine ( 9 ). As described in a recent report from the National Academies and the NAM— Toward Equitable Innovation in Health and Medicine: A Framework— this will require considering the many types of equity in science and technology innovation and how to incorporate them across stages of the innovation life cycle—from conceiving and embarking on an idea, to research and development, to technological evaluation, to access and use of technology, through post-market evaluation and long-term learning. Governance for AI/ML must be able to address the various needs at every stage in the technological life cycle.

Dynamic governance for AI/ML in health and medicine must also encapsulate multiple forms of policy and rulemaking. Both “hard” governance—e.g. legally binding laws and regulations—and “soft” governance—e.g. voluntary scientific guidelines and societal standards and norms—will be necessary. The latter form will require global collaboration from the scientific community, and we can look to important past models for ethically complex research as a starting point. For example, the 1975 Asilomar Conference on Recombinant DNA, which attempted to assess the safety of gene-splicing technology, resulting in a National Institutes of Health-sanctioned biosafety framework and established precedent for transparency and self-regulation in research. Similarly, the National Academies of Sciences, Engineering, and Medicine (NASEM) partnership with the Royal Society to establish the International Commission on the Clinical Use of Human Germline Genome Editing, whose resulting report in 2020 ( 10 ) offered a pathway for clinical applications of human germline editing, as well as scientific criteria that must be met, should society ever deem it possible and reasonable, and which ultimately informed World Health Organization guidance on somatic and germline editing.

In considering “hard” governance, we will also need to work together as national and international communities to achieve the right balance of guardrails and incentives. This will require continued priority-setting at the highest levels of government; thorough understanding of technology transfer and intellectual property needs; revamped pre- and post-market analysis and monitoring methods, including equity into purchasing, use, and coverage decisions; and ultimate decision-making driven by equity science and evaluation.

Despite clear needs in the United States, we cannot and should not pursue AI-related scientific advances in a vacuum. To achieve the massive improvements in scale and infrastructure necessary within the United States, we can turn to international collaborative efforts to achieve scale and avoid costly duplicative efforts. Further, as noted in a 2021 report from Brookings Institute ( 11 ), the massive challenges of our time require all-of-society approaches. As our world becomes increasingly interconnected, we also face increasingly complex challenges in health and healthcare: infectious disease epidemics and the possibility of future pandemics, climate change, rising prevalence of noncommunicable diseases, an aging global population, and the long-term impacts of systemic racism and other inequities. These present true existential threats to global health that expand far beyond the borders of any one country. Large scale collaborative efforts—driven by advances in science and technology—are the only realistic path forward to achieving improved global health and reducing disparities.

Current federal efforts offer initial promise in this area. For example, the White House named Vice President Kamala Harris as head of the US delegation for the recent AI Safety Summit in the United Kingdom ( 12 ). The US Department of State is heavily involved in the Organization for Economic Cooperation and Development AI Policy Observatory ( 13 ), a platform to shape global public policies for responsible, trustworthy, and beneficial AI. The United States is also a founding member of the Global Partnership on Artificial Intelligence (GPAI), an international and multistakeholder initiative to guide the responsible development and use of AI, grounded in human rights, inclusion, diversity, innovation, and economic growth. The GPAI aims to bridge the gap between theory and practice on AI by supporting cutting-edge research and applied activities on AI-related priorities ( 14 ). But we lack a true vision of international AI collaboration and governance, and there remains a need for a strong health and health systems perspective in these discussions.

In considering collaborative research efforts, the National Science Foundation's (NSF) AI Research Institutes are advancing foundational research, conducting use-inspired research, and striving to build the next generation of talent within a diverse, well-trained workforce. These institutes provide a strong model for multidisciplinary and multi-organizational collaboration. Still, advancement of AI is a task that is larger than one country can handle alone. The NSF has selected opportunities to support international partnerships, but we must build on current efforts to further investment in programs that promote the collaboration of the United States and foreign partners on AI research. This allows a global sharing experience in the development of AI tools that is more diverse and inclusive of the needs of the global citizens. The NSF could further incorporate international partners in the AI labs by officializing designated international partners, and we must look beyond individual centers or singular efforts to drastically expand scope and scale of collaboration.

AI has huge potential to advance the field of health and medicine but faces major challenges with respect to equity, oversight, and regulation. These issues are crucial, but there are other major investments required to realize the vast potential of AI for health and healthcare which are also deserving of attention at the federal level. These include making major advances in infrastructure; building out a dynamic, mission-driven governance framework for continuing innovation; and expanding capacity for international collaboration to address the major health challenges of our time. And we must consider all of this through the lens of equity, to ensure the benefits of AI are shared by all with a goal of mitigating and preventing potential harms. For AI to achieve the scale and efficiency required to solve complex societal problems, we must act now to provide a strong foundation for growth and discovery.

Bertagnolli M . 2023 . Advancing health through artificial intelligence/machine learning: the critical importance of multidisciplinary collaboration . PNAS Nexus . https://doi.org/10.1093/pnasnexus/pgad356 .

The White House . Executive order on the safe, secure, and trustworthy development and use of artificial intelligence . 2023 . https://www.whitehouse.gov/briefing-room/presidential-actions/2023/10/30/executive-order-on-the-safe-secure-and-trustworthy-development-and-use-of-artificial-intelligence/

National Academies . Toward equitable innovation in health and mediticine: a framework . 2023 . https://nap.nationalacademies.org/catalog/27184/toward-equitable-innovation-in-health-and-medicine-a-framework

National Academies . AI for scientific discovery—a workshop . 2023 . https://www.nationalacademies.org/our-work/ai-for-scientific-discovery-a-workshop

National Academy of Medicine . Generative AI & LLMs in health & medicine . 2023 . https://nam.edu/event/generative-ai-llms-in-health-medicine/

Mulholland   R , et al.    2021 . Cohort profile: early pandemic evaluation and enhanced surveillance of COVID-19 (EAVE II) database . Int J Epidemiol . 50 ( 4 ): 1064 – 1074 . https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8195245/

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The White House Office of Science and Technology Policy . Blueprint for an AI bill of rights: making automated systems work for the American people . 2022 . https://www.whitehouse.gov/ostp/ai-bill-of-rights/

Collingridge   D . 1982 . The social control of technology . London : Continuum International Publishing Group .

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Mathews   DJH , Balatbat   CA , Dzau   VJ . 2022 . Governance of emerging technologies in health and medicine—creating a new framework . N Engl J Med . 386 ( 23 ): 2239 – 2242 . https://www.nejm.org/doi/10.1056/NEJMms2200907?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

National Academy of Medicine, National Academy of Sciences, Royal Society . 2020 . Heritable human genome editing . Washington (DC) : National Academies Press . https://nap.nationalacademies.org/catalog/25665/heritable-human-genome-editing

Kerry   CF , Meltzer   JP , Renda   A , Engler   A , Fanni   R . Strengthening international cooperation on AI: progress report . Brookings . 2021 . https://www.brookings.edu/articles/strengthening-international-cooperation-on-ai

The White House . Fact sheet: Vice President Harris announces new US initiatives to advance the safe and responsible use of artificial intelligence . 2023 . https://www.whitehouse.gov/briefing-room/statements-releases/2023/11/01/fact-sheet-vice-president-harris-announces-new-u-s-initiatives-to-advance-the-safe-and-responsible-use-of-artificial-intelligence/

US Department of State . Artificial intelligence (AI) . https://www.state.gov/artificial-intelligence/

US Department of State . Joint statement from founding members of the global partnership on artificial intelligence . 2020 . https://www.state.gov/joint-statement-from-founding-members-of-the-global-partnership-on-artificial-intelligence/

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NIMH marks 75 years of mental health research

November/december 2023 | volume 22 number 6.

By Judy Coan-Stevens

Since its founding in 1949, the National Institute of Mental Health (NIMH) has transformed the understanding and treatment of mental illnesses through basic and clinical research, bringing hope to millions of people. In recent decades, global health researchers have placed new emphasis on mental health against the backdrop of natural disasters, armed conflict, forced displacement, and major disease outbreaks. Mental disorders and diseases are an enormous burden in low- and middle-income countries (LMICs) which lack the financial and human resources to deal with them. According to the WHO World mental health report  published in June 2022, mental disorders are the leading cause of years lived with disability (YLDs), accounting for one in every six YLDs globally. This report also indicates that worldwide one in eight individuals live with a mental health condition. However, these mental health conditions remain undertreated and health services continue to be underfunded.

A world map highlighting the countries that participate the NIMH-supported Research Partnerships for Scaling Up Mental Health Interventions in Low- and Middle-Income Countries (Scale-Up Hubs). East Asia and the Pacific: Australia, China, Papua New Guinea. Timor – Leste, Vietnam. Eurasia: South and Central Asia: Afghanistan, Bangladesh, Burma (Myanmar), India, Nepal, Pakistan, Thailand. Europe:, United Kingdom. Middle East & North Africa: Egypt, Iran, Jordan. Sub-Saharan Africa: Botswana, Ghana, Kenya, Liberia, Malawi, Mozambique, Sierre Leone, South Africa, Tanzania, Uganda, Zambia. Americas and the Caribbean (Western Hemisphere) :, Chile, Colombia, Peru, United States.

NIMH's vision statement “envisions a world in which mental illnesses are prevented and cured." Global mental health research is one of the Institute's priority research areas.As Leonardo Cubillos and Collene Lawhorn of the Center for Global Mental Health Research within NIMH wrote in a recent blog post , “Mental illnesses are not confined by geography; our research should not be either.” The Center coordinates efforts to generate knowledge that will improve the lives of people living with or at risk for mental illnesses in LMICs. Two of the Center’s flagship dissemination and capacity-building initiatives are the biannual Global Mental Health Conference , which gathered for its 12 th meeting earlier this year, and the Global Mental Health Research Webinar Series . The center currently prioritizes supporting implementation science and health services research applied to key global mental health challenges, such as integration of mental health care in primary care, suicide prevention, mobile populations, and social determinants of mental health.

For several decades, NIMH has been an important partner to Fogarty on programs such as Emerging Global Leader, International Research Scientist Development Award (IRSDA), Global Brain Disorders Research, Global Health Fellows and Scholars/ LAUNCH, and Chronic, Noncommunicable Diseases and Disorders Research Training (NCD-Lifespan). NIMH has provided support to Fogarty trainees as they progress in their careers. With this support, Fogarty trainees and grant recipients have measured the prevalence of mental disorders in western Kenya , where no baseline had been established; studied the benefits of including fathers when providing mental health services to displaced Syrian families living in Turkey; researched how mental health care can be normalized in wartime Ukraine ; and measured the impact of apartheid-based prenatal stress and COVID-19 in South Africa . Including diverse populations, communities, contexts, geographical regions, researchers, and technologies across the globe can accelerate and enrich scientific advancements while helping to address challenges both globally and domestically.

NIMH is marking this milestone with special events, videos, podcasts, and feature stories that highlight the Institute's research and its impact on mental health. All are listed on Celebrating 75 Years of Research, Discovery, and Hope website.

More Information

  • Celebrating 75 Years of Research, Discovery, and Hope
  • Center for Global Mental Health Research at NIMH
  • Going Global: Advancing Mental Health Research Around the World , NIMH Director's Message , November 15, 2023
  • Recent stories about NIMH-supported research from Global Health Matters
  • This researcher wants to normalize mental health care in Ukraine
  • Bringing evidence-based care to Ukrainians suffering from PTSD
  • Edith Kwobah: Measuring the prevalence of mental disorders in western Kenya
  • Employing user-centered design to fill gaps in mental health treatment
  • Addressing mental health abroad helps US communities
  • Researchers study refugee families' mental health needs

Udpated November 30, 2023

To view Adobe PDF files, download current, free accessible plug-ins from Adobe's website .

Related Global Health Research Topics

  • Neurological and mental disorders and diseases

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HRS International Family of Studies and the Harmonized Cognitive Assessment Protocol

On this page:

Health and Retirement Study & HRS International Family of Studies

Harmonized cognitive assessment protocol, hrs and hcap research resources.

The Health and Retirement Study (HRS) is a longitudinal panel study that surveys a nationally representative sample of approximately 20,000 people in the United States aged 50 and older, supported by NIA ( U01AG009740 ) and the Social Security Administration. The HRS International Family of Studies provides nationally representative, longitudinal data with multidisciplinary content for individual countries. These studies are modeled after the HRS in the U.S.

Through in-depth interviews, the HRS International Family of Studies provides an invaluable and growing body of multidimensional data related to economics and health. Researchers can use these data to address important research questions on aging and offer the opportunity for cross-national comparisons.

The HRS International Family of Studies are designed to facilitate research across multiple international contexts. In addition, these studies share key principles:

  • Nationally representative
  • Longitudinal
  • Multidisciplinary
  • Internationally comparable (harmonized)
  • Data sharing
  • Rich cognitive assessment
  • Bio sample collection

These studies provide publicly available, harmonized, multidisciplinary longitudinal data, including biomarkers and physical performance measures, on aging and the health and well-being of the older population, with dedicated sub-studies focused on cognitive aging and dementia. Information related to these studies and links to the datasets are available on the NIA-supported Gateway to Global Aging .

Before You Apply

Visit our Before You Apply for a Global Aging Behavioral and Social Research Project page to learn more about next steps before starting your grant application.

The HRS International Family of Studies include:

  • Brazilian Longitudinal Study of Aging (ELSI-Brazil)
  • The China Health and Retirement Longitudinal Study (CHARLS)
  • Costa Rican Longevity and Healthy Aging Study (CRELES)
  • The Caribbean-American Dementia and Aging Study (CADAS) (Dominican Republic and Puerto Rico)
  • English Longitudinal Study of Ageing (ELSA)
  • Survey of Health, Aging, and Retirement in Europe (SHARE)
  • Longitudinal Aging Study in India (LASI)
  • Indonesia Family Life Survey (IFLS)
  • The Irish Longitudinal Study on Ageing (TILDA)
  • Japanese Study of Aging and Retirement (JSTAR)
  • Longitudinal Study of Health and Ageing in Kenya (LOSHAK)
  • Lebanon Study on Aging and HeAlth (LSAHA)
  • Malaysia Ageing and Retirement Survey (MARS)
  • Malawi Longitudinal Study of Families and Health (MLSFH)
  • Mexican Health and Aging Study (MHAS)
  • Chitwan Valley Family Study (Nepal)
  • The Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA)
  • Healthy AGeing in Scotland (HAGIS)
  • Health and Aging in Africa: A Longitudinal Study in South Africa (HAALSI)
  • Korean Longitudinal Study of Aging (KLoSA)
  • Health, Aging, and Retirement in Thailand (HART)
  • Health and Retirement Study (U.S.) (HRS)

The Harmonized Cognitive Assessment Protocol (HCAP) is a sub-study within the HRS in the U.S. and within some of the studies in the HRS International Family of Studies. The HCAP seeks to measure and understand dementia risk by collecting a carefully selected set of established cognitive and neuropsychological assessments and informant reports to better characterize cognitive function among older people. As the HCAP is part of the larger HRS, these studies are especially good for studying risk and protective factors related to Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD) in the context of well-characterized longitudinal, population-representative social surveys. The details about the 2016 HCAP protocol can be found here (PDF, 442K).

HCAP studies around the world include:

  • China Health and Retirement Longitudinal Study (CHARLS)
  • English Longitudinal Study of Ageing: Healthy Cognitive Aging Project (ELSA-HCAP)
  • Longitudinal Aging Study in India: Diagnostic Assessment of Dementia (LASI-DAD)
  • Mexican Health and Aging Study: Cognitive Aging Ancillary Study (Mex-Cog)
  • Health and Aging in Africa: Longitudinal Studies in Three INDEPTH Communities (HAALSI)
  • Harmonized Cognitive Assessment Protocol (HCAP) (U.S.)

The Division of Behavioral and Social Research also supports networks and infrastructure to develop and use HRS and HCAP data for cross-national studies. The HRS Around the World and HCAP Networks serve as a resource for those interested in conducting studies in their own countries. The Gateway to Global Aging provides information related to available data. If interested in submitting an application, visit the Before You Apply for a Global Aging Behavioral and Social Research Project page for more information.

The Health and Retirement Studies Around the World  network fosters collaboration among researchers to ensure harmonization of data elements and methods across the HRS International Family of Studies. The network also supports pilots to develop new survey methodology or establish comparability for research across studies.

The HCAP Network supports a group of researchers working together to support harmonization of international studies using the harmonized cognitive assessment protocol. The goal of the HCAP Network is to develop international data resources for the study of AD/ADRD. The HCAP Network facilitates harmonization of cognitive tests and measures necessary for good comparative research through a range of activities.

The Gateway to Global Aging facilitates cross-national and longitudinal studies of aging from the HRS International Family of Studies from around the world. The resource provides comparisons of measures across surveys, data downloads to harmonized datasets and codebooks, visualization tools based on the harmonized data, and publications based on surveys. In addition, the Gateway website includes a compilation of COVID data across several studies that can be used for comparative analyses.

Back to BSR’s Global Aging Page

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WHO Releases the Global Status Report on Road Safety 2023

On December 13, 2023, the World Health Organization (WHO) officially launched the Global Status Report on Road Safety 2023—a document that presents the developments that took place during the Decade of Action for Road Safety 2011–2020. The document also provides baseline data for the Decade of Action for Road Safety 2021–2030.  In addition, it breaks down the road safety landscape of United Nations Member States, addresses changes that have occurred since the release of previous editions, aims to empower the network of individuals involved in initiatives at a global scale, and much more. The WHO will soon provide versions of the report in Spanish, French, Russian, Chinese, and Arabic.

  • Consult the report  here .
  • Read the official press release  here .
  • Explore the Road Safety Data app with this  QR code .

ScienceDaily

Exercise can boost brain health

A fascinating link between regular exercise and better brain health has been revealed, according to an international study that included a team of clinical researchers from Pacific Neuroscience Institute's Brain Health Center, located at Providence Saint John's Health Center.

The research, detailed in the paper "Exercise-Related Physical Activity Relates to Brain Volumes in 10,125 Individuals," was published this week in the Journal of Alzheimer's Disease and shows being physically active is related to increased size of brain areas important for memory and learning.

The study looked at MRI brain scans from 10,125 people done at Prenuvo imaging centers, a key collaborator in the research. It found those who regularly engaged in physical activities such as walking, running or sports had larger brain volumes in key areas. This includes the gray matter, which helps with processing information, and the white matter, which connects different brain regions, as well as the hippocampus, important for memory.

Cyrus A. Raji, M.D., the lead researcher, explains the findings in simple terms: "Our research supports earlier studies that show being physically active is good for your brain. Exercise not only lowers the risk of dementia but also helps in maintaining brain size, which is crucial as we age."

David Merrill, M.D., study co-author and director of the PBHC noted, "We found that even moderate levels of physical activity, such as taking fewer than 4,000 steps a day, can have a positive effect on brain health. This is much less than the often-suggested 10,000 steps, making it a more achievable goal for many people."

Study co-authorSomayeh Meysami, M.D. , assistant professor of neurosciences at Saint John's Cancer Institute and the Pacific Brain Health Center noted, "Our research links regular physical activity to larger brain volumes, suggesting neuroprotective benefits. This large sample study furthers our understanding of lifestyle factors in brain health and dementia prevention . "

A Lancet Study in 2020 found about a dozen modifiable risk factors increase risk for Alzheimer's disease, including physical activity. This work builds upon previous work by this group, linking caloric burn from leisure activities to improved brain structure.

"This study demonstrates the influence of exercise on brain health imaging and when added to other studies on the role of diet, stress reduction and social connection offer the proven benefits of drug-free modifiable factors in substantially reducing Alzheimer's disease," said George Perry, Editor-in-Chief of Journal of Alzheimer's Disease.

"With comprehensive imaging scans, our study underscores the interconnected synergy between the body and the brain. It echoes the knowledge of past generations, showcasing that increased physical activity is a predictor of a healthier aging brain," said Dr. Attariwala, senior author of this paper.

This research highlights an easy way to keep our brains healthy: stay active! Whether it's a daily walk or a favorite sport, regular physical activity can have lasting benefits for our brain health.

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  • Intelligence
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  • Cyrus A. Raji, Somayeh Meysami, Sam Hashemi, Saurabh Garg, Nasrin Akbari, Gouda Ahmed, Yosef Gavriel Chodakiewitz, Thanh Duc Nguyen, Kellyann Niotis, David A. Merrill, Rajpaul Attariwala. Exercise-Related Physical Activity Relates to Brain Volumes in 10,125 Individuals . Journal of Alzheimer's Disease , 2023; 1 DOI: 10.3233/JAD-230740

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Recruitment of volunteers will be competitive. A maximum of 450 children aged 12 to 17 years inclusive will be screened in the study, of which it is planned to include and randomize 300 children who meet the criteria for inclusion in the study and do not have non-inclusion criteria, data on which will be used for subsequent safety and immunogenicity analysis.

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Paul • Male or female.

Reproductive characteristics

  • For girls with a history of mensis - a negative pregnancy test and consent to adhere to adequate methods of contraception (use of contraceptives within a month after the second vaccination). Girls should use methods of contraception with a reliability of more than 90% (cervical caps with spermicide, diaphragms with spermicide, condoms, intrauterine spirals).
  • For young men capable of conception - consent to adhere to adequate methods of contraception (use of contraceptives within a month after the second vaccination). Young men and their sexual partners should use methods of contraception with a reliability of more than 90% (cervical caps with spermicide, diaphragms with spermicide, condoms, intrauterine spirals).

Research procedures

  • Written Informed consent of a volunteer (14 years and older) and one of the parents to participate in a clinical trial.
  • Volunteers who are able to fulfill Protocol requirements (i.e. answer phone calls, fill out a Self-observation Diary, come to control visits).

Non-inclusion criteria:

  • Volunteers cannot be included in the study if any of the following criteria are present:

SARS-CoV-2 infection

  • A case of established COVID-19 disease confirmed by PCR and/or ELISA in the last 6 months.
  • History of contacts with confirmed or suspected cases of SARS-CoV-2 infection within 14 days prior to vaccination.
  • Positive IgM or IgG to SARS-CoV-2 detected on Screening.
  • Positive PCR test for SARS-CoV-2 at Screening / before vaccination.

Diseases or medical conditions

  • Serious post-vaccination reaction (temperature above 40 C, hyperemia or edema more than 8 cm in diameter) or complication (collapse or shock-like condition that developed within 48 hours after vaccination; convulsions, accompanied or not accompanied by a feverish state) to any previous vaccination.
  • Burdened allergic history (anaphylactic shock, Quincke's edema, polymorphic exudative eczema, serum sickness in the anamnesis, hypersensitivity or allergic reactions to the introduction of any vaccines in the anamnesis, known allergic reactions to vaccine components, etc.).
  • Guillain-Barre syndrome (acute polyradiculitis) in the anamnesis.
  • The axillary temperature at the time of vaccination is more than 37.0 ° C.
  • Positive blood test for HIV, syphilis, hepatitis B/C.
  • Acute infectious diseases (recovery earl

Exclusion Criteria:

- • Withdrawal of Informed consent by a volunteer and/or a parent of a volunteer;

  • The volunteer was included in violation of the inclusion/non-inclusion criteria of the Protocol;
  • Availability of inclusion/non-inclusion criteria before vaccination;
  • Any condition of a volunteer that requires, in the reasoned opinion of a medical researcher, the withdrawal of a volunteer from the study;
  • The established fact of pregnancy before the second vaccination;
  • Taking unauthorized medications (see section 6.2);
  • The volunteer's incompetence with the study procedures;
  • The volunteer refuses to cooperate or is undisciplined (for example, failure to attend a scheduled visit without warning the researcher and/or loss of communication with the volunteer), or dropped out of observation;
  • For administrative reasons (termination of the study by the Sponsor or regulatory authorities), as well as in case of gross violations of the protocol that may affect the results of the study.
  • For Patients and Families
  • For Researchers
  • For Study Record Managers
  • Customer Support
  • Viewers and Players
  • Freedom of Information Act
  • HHS Vulnerability Disclosure
  • U.S. National Library of Medicine
  • U.S. National Institutes of Health

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The Fogarty International Center is dedicated to advancing the mission of NIH by supporting and facilitating global health research conducted by U.S. and international investigators, building partnerships between health research institutions in the United States and abroad, and training the next generation of scientists to address global health ...

Note that processing time for human subjects research approval can vary widely from country to country. In order to plan your research timeline, you should seek advice about this timeframe from your in-country collaborator. The US Office of Human Research Protections compiles a listing of research standards in 130+ countries. This document ...

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The International Journal for Quality in Health Care ( IJQHC) is a leading international peer-reviewed scholarly journal addressing research, policy, and implementation related to the quality of health care and health outcomes for populations and patients worldwide. Read more.

The International Healthcare Research Center is a 501c (3) non-profit research center, dedicated to conducting research and delivering reliable information and actionable strategic insight in the following areas: International patient experiences & outcomes; Trends & analysis of international patient care; Global health insurance

Coronavirus news and resources for global health researchers. Fogarty grantees, trainees and fellows across geographic areas and research disciplines are helping to lead and support COVID- 19 response efforts and research activities in some low-resource countries and regions. Coronavirus news and resources.

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Research for health spans 5 generic areas of activity: measuring the magnitude and distribution of the health problem; understanding the diverse causes or the determinants of the problem, whether they are due to biological, behavioural, social or environmental factors;

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Since 2013 he has been involved in two health-related research projects (also covering ageing topics) in Russia in the following positions: Head of the Research Laboratory on the Economics of Health and Health Reform at the Russian Presidential Academy of the National Economy and Public Administration in Moscow and International Research Fellow ...

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Since its founding in 1949, the National Institute of Mental Health (NIMH) has transformed the understanding and treatment of mental illnesses through basic and clinical research, bringing hope to millions of people. In recent decades, global health researchers have placed new emphasis on mental health against the backdrop of natural disasters ...

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State Budgetary Healthcare Institution of the Moscow region "Elektrostal Central City Hospital" Elektrostal, Moscow Oblast, Russian Federation, 144000 : Federal State Budgetary Scientific Institution "I.I. Mechnikov Scientific Research Institute of Vaccines and Serums" Moscow, Russian Federation, 105064 : FSBSI Chumakov FSC R&D IBP RAS

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    Care is hence conceived of as a combination of (1) reflexivity (self-awareness), (2) intentionality (being oriented towards the other), (3) affectivity (goodwill), and (4) spontaneity (immediacy). Medical ethics initially dedicated itself to principlism, which promised manageability of ethical problems. Only gradually, it was realised that the ...

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