BACKGROUND & AIMS: :Recognizing that robust information on health systems in other countries can provide valuable lessons for the English National Health Service, the Department of Health commissioned an academic team to provide an 'On-call Facility for International Healthcare Comparisons' in 2005. This paper describes the work of this novel approach to informing policy and reviews the experience of the first two years. It illustrates the well-documented challenges of comparative analysis of health systems. One important issue is understanding the health system context so as to interpret phenomena and draw appropriate policy conclusions. Other challenges include the potential tension between academic interest and rigour, and the need for timely analysis to inform the Department of Health's rapidly changing policy agenda. The diversity and nature of topics covered, as well as the rapid turn-around time have meant that the Facility has had to balance rigour and timeliness carefully to ensure the value and relevance of reports. A strong research base linked with an international network of country experts promotes the provision of high quality analyses at relatively low costs. However, such an arrangement can only be sustained if it provides scope for additional primary research. A formal evaluation of the influence on health care policy-making in England is not yet available. Such knowledge will be of crucial importance for the development of similar resources elsewhere.

背景与目标： ：卫生部认识到其他国家/地区强大的卫生系统信息可以为英国国家卫生服务局提供宝贵的经验，因此在2005年委托一个学术团队提供“国际医疗比较的待命服务”。这种新颖的方法来指导政策并回顾前两年的经验。它说明了卫生系统比较分析中有据可查的挑战。一个重要的问题是了解卫生系统的背景情况，以便解释现象并得出适当的政策结论。其他挑战包括学术兴趣和严格性之间的潜在紧张关系，以及需要及时分析以告知卫生部迅速变化的政策议程的挑战。所涉主题的多样性和性质以及快速的周转时间，意味着该基金必须认真权衡严格性和及时性，以确保报告的价值和相关性。强大的研究基础与国家专家的国际网络相联系，促进了以相对较低的成本提供高质量的分析。但是，只有为其他基础研究提供了范围，这样的安排才能维持下去。目前尚无关于英格兰对卫生保健政策制定影响的正式评估。这些知识对于开发其他地方的类似资源至关重要。

BACKGROUND & AIMS: BACKGROUND:Meta-analyses enable summarization and interpretation of data across clinical trials. When applied to safety data they allow for detection of rare events. Recently, a 13-valent pneumococcal conjugate vaccine (PCV13) was approved in multiple countries worldwide for routine immunization of infants and young children. This meta-analysis was conducted to identify potentially clinically important rare safety events associated with PCV13. OBJECTIVE:To summarize the safety of PCV13 compared with 7-valent pneumococcal conjugate vaccine (PCV7) administered to infants and toddlers. METHODS:A meta-analysis was performed of integrated safety data from 13 infant studies (PCV13 n=4729 and PCV7 n=2760) conducted in 9 North American, European, and Asian countries. Local reactions at the vaccine injection site and systemic events were collected for 4-7 days after each dose into electronic diaries. Adverse events (AEs) were collected after each vaccination. RESULTS:Overall, rates of local reactions after any dose of the infant series were similar between PCV13 and PCV7 groups: tenderness (46.7% vs 44.8%, respectively); swelling (28.5% vs 26.9%); and redness (36.4% vs 33.9%). After the toddler dose, tenderness was significantly higher among PCV7 subjects than PCV13 subjects (54.4% vs 48.8%; P=0.005). Frequencies of fever (≥38°C) were similar in both groups and mostly mild (≤39°C); incidence of moderate fever (>39°C to ≤40°C) with PCV13 was ≤2.8% after any infant dose and 5.0% after the toddler dose, compared with ≤2.6% and 7.3%, respectively, with PCV7. Fever >40°C was uncommon in both groups. Frequencies of decreased appetite, irritability, and sleep disturbances were similar in both groups. AEs were the types of conditions and symptoms expected in infants and children, and clinically significant differences between vaccine groups were not observed. CONCLUSION:PCV13 has a favorable safety profile similar to that of PCV7, a vaccine for which there is >10 years clinical experience.

背景与目标： 背景：元分析可以汇总和解释整个临床试验中的数据。当应用于安全数据时，它们允许检测罕见事件。最近，一种13价肺炎球菌结合疫苗（PCV13）已在全球多个国家/地区批准用于婴儿和幼儿的常规免疫。进行这项荟萃分析，以鉴定与PCV13相关的潜在的临床上重要的罕见安全事件。
目的：总结与婴幼儿使用的7价肺炎球菌结合疫苗（PCV7）相比，PCV13的安全性。
方法：对9个北美，欧洲和亚洲国家进行的13项婴儿研究（PCV13 n = 4729和PCV7 n = 2760）的综合安全性数据进行了荟萃分析。每次注射疫苗后4-7天，将疫苗注射部位的局部反应和全身性事件收集到电子日记中。每次疫苗接种后收集不良事件（AE）。
结果：总的来说，在PCV13和PCV7组中，任何剂量的婴儿系列后的局部反应率相似：压痛（分别为46.7％和44.8％）；肿胀（28.5％对26.9％）;和发红（36.4％比33.9％）。幼儿服药后，PCV7受试者的压痛明显高于PCV13受试者（54.4％比48.8％； P = 0.005）。两组的发烧频率（≥38°C）相似，且多数为轻度（≤39°C）。在任何婴儿剂量下，PCV13发生中度发烧（> 39°C到≤40°C）的发生率≤2.8％，在幼儿剂量后为5.0％，而PCV7分别为≤2.6％和7.3％。两组中发烧> 40°C的情况很少见。两组食欲减退，烦躁不安和睡眠障碍的频率相似。不良事件是婴儿和儿童中预期的疾病和症状类型，未观察到疫苗组之间的临床显着差异。
结论：PCV13具有与PCV7类似的良好安全性，后者具有10年以上的临床经验。

BACKGROUND & AIMS: :We have conducted a systematic review to update available information on plasmid-mediated colistin resistance (mobilized colistin resistance [mcr]) genes in North African countries. We have searched the articles of PubMed, Scopus, and Web of Science databases reporting plasmid-mediated colistin resistance bacteria isolated in North African countries. After searching and selection, 30 studies that included 208 mcr-positive isolates were included. Different mcr-positive strains frequencies were recorded and ranged from 2% in clinical isolates to 12.3% in environmental samples. Escherichia coli was the predominant species recorded and these microorganisms showed high resistance to ciprofloxacin and cotrimoxazole. IncHI2 plasmids are probably the key vectors responsible for the dissemination of mcr genes in these countries. This review highlighted that the mcr-positive isolates are circulating in different ecological niches with different frequencies. Therefore, actions should be implemented to prevent the dissemination of the mcr genes within and outside of these countries, such as microbiological and molecular surveillance programs and restriction use of colistin in farming.

背景与目标： ：我们进行了系统的综述，以更新北非国家中质粒介导的大肠菌素抗性（动员大肠菌素抗性[mcr]）基因的可用信息。我们搜索了PubMed，Scopus和Web of Science数据库的文章，这些文章报告了在北非国家分离的质粒介导的大肠菌素抗性细菌。经过搜索和选择，纳入了包括208个mcr阳性分离株的30个研究。记录了不同的mcr阳性菌株频率，范围从临床分离株的2％到环境样品的12.3％。大肠杆菌是记录的主要物种，这些微生物显示出对环丙沙星和卡曲美唑的高抗性。 IncHI2质粒可能是在这些国家/地区传播mcr基因的关键载体。这篇综述强调了mcr阳性分离株在不同生态位中以不同的频率传播。因此，应采取行动防止在这些国家内外传播mcr基因，例如微生物和分子监测计划以及限制大肠菌群的使用。

BACKGROUND & AIMS: Background:Health information exchange (HIE) is frequently cited as an important objective of health information technology investment because of its potential to improve quality, reduce cost, and increase patient satisfaction. In this paper we examine the status and practices of HIE in six countries, drawn from a range of higher and lower income regions. Methods:For each of the countries represented - China, England, India, Scotland, Switzerland, and the United States - we describe the state of current practice of HIE with reference to two scenarios: transfer of care and referral. For each country we discuss national objectives, barriers and plans for further advancing clinical information exchange. Results:The countries vary widely in levels of adoption of EHRs, availability of health information in electronic form suitable for HIE, and in the information technology infrastructure to be used for transmission. Common themes emerged, however, including an expectation that information will be exchanged rather than gathered anew, the need for incentives to promote information exchange, and concerns about data security and patient confidentiality. Conclusions:Although the ability to transfer health information to where it is most needed is nearly always mentioned as an advantage of HIE adoption, there are wide differences in the degree to which this has been achieved to support the scenarios used in this study. Nevertheless, these differences indicate varying stages of progress along a comparable pathway, with similar barriers being identified in the countries described. In some cases, these have been partially surmounted while elsewhere work is needed. We reflect on contextual factors influencing the status and direction of HIE efforts in different global regions and their implications for progress.

背景与目标： 背景：健康信息交换（HIE）经常被认为是健康信息技术投资的重要目标，因为它具有提高质量，降低成本和提高患者满意度的潜力。在本文中，我们从六个高收入和低收入地区中考察了六个国家中HIE的现状和实践。
方法：对于代表的每个国家（中国，英国，印度，苏格兰，瑞士和美国），我们参考两种情况描述了HIE的当前实践状况：护理转移和转诊。对于每个国家，我们都讨论了进一步推进临床信息交换的国家目标，障碍和计划。
结果：各国在采用电子病历的水平，适用于HIE的电子形式的健康信息的可获得性以及用于传输的信息技术基础设施方面差异很大。然而，出现了共同的主题，包括期望交换信息而不是重新收集信息，对促进信息交换的激励措施的需求以及对数据安全性和患者机密性的担忧。
结论：尽管几乎总是提到将健康信息传输到最需要的地方的能力，这是采用HIE的优势，但在支持本研究中所用方案的程度上却存在很大差异。然而，这些差异表明，在可比的道路上，进展阶段各不相同，在上述国家中也发现了类似的障碍。在某些情况下，这些已被部分覆盖，而其他地方则需要进行工作。我们思考影响全球不同地区HIE努力的状态和方向的背景因素及其对进展的影响。

BACKGROUND & AIMS: Importance:Depression is associated with incidence of and premature death from cardiovascular disease (CVD) and cancer in high-income countries, but it is not known whether this is true in low- and middle-income countries and in urban areas, where most people with depression now live. Objective:To identify any associations between depressive symptoms and incident CVD and all-cause mortality in countries at different levels of economic development and in urban and rural areas. Design, Setting, and Participants:This multicenter, population-based cohort study was conducted between January 2005 and June 2019 (median follow-up, 9.3 years) and included 370 urban and 314 rural communities from 21 economically diverse countries on 5 continents. Eligible participants aged 35 to 70 years were enrolled. Analysis began February 2018 and ended September 2019. Exposures:Four or more self-reported depressive symptoms from the Short-Form Composite International Diagnostic Interview. Main Outcomes and Measures:Incident CVD, all-cause mortality, and a combined measure of either incident CVD or all-cause mortality. Results:Of 145 862 participants, 61 235 (58%) were male and the mean (SD) age was 50.05 (9.7) years. Of those, 15 983 (11%) reported 4 or more depressive symptoms at baseline. Depression was associated with incident CVD (hazard ratio [HR], 1.14; 95% CI, 1.05-1.24), all-cause mortality (HR, 1.17; 95% CI, 1.11-1.25), the combined CVD/mortality outcome (HR, 1.18; 95% CI, 1.11-1.24), myocardial infarction (HR, 1.23; 95% CI, 1.10-1.37), and noncardiovascular death (HR, 1.21; 95% CI, 1.13-1.31) in multivariable models. The risk of the combined outcome increased progressively with number of symptoms, being highest in those with 7 symptoms (HR, 1.24; 95% CI, 1.12-1.37) and lowest with 1 symptom (HR, 1.05; 95% CI, 0.92 -1.19; P for trend < .001). The associations between having 4 or more depressive symptoms and the combined outcome were similar in 7 different geographical regions and in countries at all economic levels but were stronger in urban (HR, 1.23; 95% CI, 1.13-1.34) compared with rural (HR, 1.10; 95% CI, 1.02-1.19) communities (P for interaction = .001) and in men (HR, 1.27; 95% CI, 1.13-1.38) compared with women (HR, 1.14; 95% CI, 1.06-1.23; P for interaction < .001). Conclusions and Relevance:In this large, population-based cohort study, adults with depressive symptoms were associated with having increased risk of incident CVD and mortality in economically diverse settings, especially in urban areas. Improving understanding and awareness of these physical health risks should be prioritized as part of a comprehensive strategy to reduce the burden of noncommunicable diseases worldwide.

背景与目标： 重要性：抑郁症与高收入国家的心血管疾病（CVD）和癌症的发生和过早死亡有关，但尚不清楚在低收入和中等收入国家以及大多数人所在的城市地区是否如此抑郁症现在生活。
目的：确定经济发展水平不同的国家和城乡地区的抑郁症状与心血管疾病和全因死亡率之间的关系。
设计，背景和参与者：这项基于人群的多中心队列研究于2005年1月至2019年6月进行（中位随访时间为9.3年），纳入了来自五大洲21个经济不同国家的370个城市社区和314个农村社区。年龄在35至70岁之间的符合条件的参与者入选。分析于2018年2月开始，至2019年9月结束。
暴露：来自简短综合国际诊断面试的四个或更多个自我报告的抑郁症状。
主要结果和措施：事件性CVD，全因死亡率，以及对事件性CVD或全因死亡率的综合测量。
结果：145862名参与者中，有61235名（58％）为男性，平均（SD）年龄为50.05（9.7）岁。在这些患者中，有15983名（11％）在基线时报告了4种或更多种抑郁症状。抑郁与突发性CVD（危险比[HR]为1.14； 95％CI为1.05-1.24），全因死亡率（HR为1.17； 95％CI为1.11-1.25），CVD /死亡率综合结果（HR）相关。在多变量模型中，分别为1.18； 95％CI，1.11-1.24），心肌梗塞（HR，1.23； 95％CI，1.10-1.37）和非心血管死亡（HR，1.21； 95％CI，1.13-1.31）。合并症状的风险随症状数量的增加而逐渐增加，在有7种症状的人群中最高（HR，1.24； 95％CI，1.12-1.37），最低的有1种症状（HR，1.05； 95％CI，0.92 -1.19） ; P表示趋势<.001）。在7个不同的地理区域和所有经济水平的国家中，具有4种或更多种抑郁症状与综合结果之间的关联相似，但与农村地区（HR）相比，城市地区（HR，1.23； 95％CI，1.13-1.34）更强，1.10； 95％CI，1.02-1.19）社区（互动率P = 0.001）和男性（HR，1.27； 95％CI，1.13-1.38），而女性（HR，1.14； 95％CI，1.06- 1.23；交互作用的P <<。001）。
结论与相关性：在这项大型的，基于人群的队列研究中，患有抑郁症状的成年人在经济上多样化的环境中，特别是在城市地区，患心血管疾病的风险增加和死亡率增加。作为减少全球非传染性疾病负担的全面战略的一部分，应优先提高对这些身体健康风险的了解和认识。

BACKGROUND & AIMS: :The aim of the current work was to evaluate the physicochemical, rheological, molecular, thermal and sensory properties of complementary food (CF) formulations prepared with quinoa (Chenopodium quinoa Willd.) flour (QF). It was observed that QF addition significantly affected the physicochemical and rheological properties of CF formulations, resulting in higher protein and crude fiber, but lower total sugar contents and increased storage (G') and loss (G″) modulus values. The glass transition temperature decreased due to QF addition. The FTIR spectra revealed the presence of aromatic amino acids derived from QF. GC, GC-MS and GC-O analyses revealed the presence of 50 aroma and 23 aroma-active compounds, among which aldehydes, alcohols and ketones were the most prevalent group of compounds. The formulation with 8% QF received the highest sensory scores. QF could be used to improve the physicochemical, rheological, thermal and sensory properties of CF products.

背景与目标： ：当前工作的目的是评估用藜麦（藜麦藜麦（Chenopodium quinoa Willd。））面粉（QF）制备的辅食（CF）制剂的理化，流变，分子，热和感官特性。观察到QF的添加显着影响CF制剂的物理化学和流变性质，导致更高的蛋白质和粗纤维，但是更低的总糖含量以及增加的储能（G'）和损失（G''）模量值。由于添加了QF，玻璃化转变温度降低了。 FTIR光谱显示存在源自QF的芳香族氨基酸。 GC，GC-MS和GC-O分析显示存在50种香气和23种香气活性化合物，其中醛，醇和酮是最常见的化合物。 QF为8％的配方获得最高的感官评分。 QF可用于改善CF产品的理化，流变，热和感官性能。

BACKGROUND & AIMS: AIMS:The factors contributing to the establishment of high-quality radiotherapy services in low- and middle-income countries (LMICs) are poorly understood. The aim was to identify and describe barriers and facilitators to establishing and sustaining high-quality and accessible radiotherapy services in LMICs based on the experience of successful and unsuccessful attempts. METHODS:An exploratory-descriptive qualitative study using semistructured telephone interviews was undertaken. Purposive and snowball sampling techniques were used to recruit participants. The World Health Organization Innovative Care for Chronic Conditions Framework informed the interview guide. A constant comparative data analysis approach was adopted. FINDINGS:Seventeen participants were interviewed. Ten were working permanently in nine LMICs and seven were permanently employed in four high-income countries. Three themes were developed: committing to a vision of improving cancer care; making it happen and sustaining a safe service; and leveraging off radiotherapy to strengthen integrated cancer care. Identified barriers included lack of political leadership continuity, lack of a coordinated advocacy effort, non-Member State of the IAEA, lack of reliable epidemiological data, lack of a comprehensive budget and lack of local expertise. Facilitators identified included strong political support, vision champion, availability of a regulator, costed cancer control plan, diversified sources of funding, responsible project manager, adoption of evidence-based practice, strategic partnerships, motivation to provide patient-centered care, and availability of supportive technology. CONCLUSIONS:Assessing the level of readiness to establish and sustain a radiotherapy service is highly recommended. Future research is recommended to develop a readiness assessment tool for radiotherapy services implementation at LMICs.

背景与目标： 目的：对在中低收入国家（LMIC）建立高质量放射治疗服务的因素知之甚少。目的是根据成功和失败尝试的经验，确定和描述在中低收入国家建立和维持高质量和可及的放射治疗服务的障碍和促进者。
方法：采用半结构化电话访谈进行了探索性描述性定性研究。目的性和滚雪球采样技术被用来招募参与者。世界卫生组织慢性病创新护理框架为采访指南提供了信息。采用了恒定的比较数据分析方法。
结果：对十七名参与者进行了采访。十个在九个中低收入国家中长期工作，七个在四个高收入国家中永久性工作。制定了三个主题：致力于改善癌症护理的愿景；使其实现并维持安全的服务；并利用放射疗法加强综合癌症治疗。所查明的障碍包括缺乏政治领导连续性，缺乏协调的宣传工作，原子能机构非成员国，缺乏可靠的流行病学数据，缺乏全面的预算以及缺乏当地专门知识。确定的促进者包括强大的政治支持，愿景支持者，可利用的监管者，成本高昂的癌症控制计划，多元化的资金来源，负责任的项目经理，采用循证实践，战略合作伙伴关系，提供以患者为中心的护理动机以及可利用的医疗服务。支持技术。
结论：强烈建议评估建立和维持放射治疗服务的准备程度。建议进行进一步的研究，以开发用于中低收入国家的放射治疗服务准备情况评估工具。

BACKGROUND & AIMS: :The main objective of this study was to assess the economic cost of Alzheimer's disease (AD) in Shanghai, China, as a pilot study for future evaluations. Sixty-seven patients with AD were interviewed, and the information of the AD-related cost and resources used was collected from October 2005 to September 2006. By retrospective analysis, annual costs were calculated and expressed in Chinese renminbi (RMB). Direct cost per patient per year averaged approximately 8,432 RMB (1,058 USD), indirect cost per patient per year was 10,568 RMB (1,326 USD), and annual costs were 19,001 RMB (2,384 USD) per patient per year in this investigation. Total cost was significantly associated with the degree of severity including cognitive function (MMSE) and activity of daily living (ADL). With the increase in the number of persons at risk for developing AD, the economic burden of AD patients in China is significantly heavy.

背景与目标： ：这项研究的主要目的是评估中国上海阿尔茨海默氏病（AD）的经济成本，作为未来评估的试点研究。采访了67例AD患者，从2005年10月至2006年9月收集了与AD相关的费用和资源信息。通过回顾性分析，计算了年度费用并以人民币（RMB）表示。在此研究中，每位患者每年的直接费用平均约为8,432元（1,058美元），每位患者每年的间接费用为10,568元（1,326美元），每位患者每年的年费用为19,001元（2,384美元）。总成本与严重程度显着相关，包括认知功能（MMSE）和日常生活活动（ADL）。随着罹患AD的风险人数增加，中国AD患者的经济负担显着增加。

BACKGROUND & AIMS: :Chronic non-communicable diseases such as epilepsy, diabetes, cardiac disease and hypertension represent a growing but neglected burden in developing countries. Rural sufferers, distant from health facilities, bear this most acutely. In response, a community care programme has been developed at Jimma University Hospital and its allied health centres in rural southwest Ethiopia. This involves general duty nurses at rural health centres being trained to provide care for chronic disease patients, with regular supervision from the hospital physicians. The programme allows treatment to be provided away from the main hospital so that those who cannot afford to travel can access care near their homes. Improved access increases the request for care, and helps to address the large unmet need for chronic disease treatment. This is a good model in which rural healthcare delivery through a team can bring widespread benefit. In this article chronic disease care is discussed with a particular focus on diabetes and epilepsy. The model can be replicated in more or less developed countries and may also be relevant for HIV care.

背景与目标： ：癫痫，糖尿病，心脏病和高血压等慢性非传染性疾病在发展中国家造成的负担正在增加，但被忽视。离卫生设施较远的农村患者承受得最为严重。作为回应，吉马大学医院及其在埃塞俄比亚西南部农村地区的专职医疗中心制定了一项社区护理计划。这需要在医院医生的定期监督下，对农村保健中心的普通值班护士进行培训，以为慢性病患者提供护理。该计划允许在总医院以外的地方提供治疗，以便那些无力旅行的人可以在家附近获得医疗服务。改善的出入途径增加了对护理的需求，并有助于解决对慢性病治疗的大量未满足需求。这是一个很好的模式，通过团队提供农村医疗保健可以带来广泛的利益。在本文中，我们将重点讨论糖尿病和癫痫病的慢性病护理。该模型可以在或多或少的发达国家中复制，也可能与HIV护理有关。

BACKGROUND & AIMS: :The aim of this study is to develop a postlaryngectomy airway climate explorer (ACE) for assessment of intratracheal temperature and humidity and of influence of heat and moisture exchangers (HMEs). Engineering goals were within-device condensation prevention and fast response time characteristics. The ACE consists of a small diameter, heated air-sampling catheter connected to a heated sensor house, containing a humidity sensor. Air is sucked through the catheter by a controlled-flow pump. Validation was performed in a climate chamber using a calibrated reference sensor and in a two-flow system. Additionally, the analyser was tested in vivo. Over the clinically relevant range of humidity values (5-42 mg H2O/l air) the sensor output highly correlates with the reference sensor readings (R2 > 0.99). The 1-1/e response times are all <0.5 s. A first in vivo pilot measurement was successful. The newly developed, verified, fast-responding ACE is suitable for postlaryngectomy airway climate assessment.

背景与目标： ：本研究的目的是开发一种喉后切除术气道气候探测器（ACE），以评估气管内温度和湿度以及热湿交换器（HME）的影响。工程目标是防止设备内凝结和具有快速响应时间的特性。 ACE由一个小直径的加热空气采样导管组成，该导管连接到包含湿度传感器的加热传感器外壳。空气由可控流量泵通过导管吸入。验证是在气候室中使用已校准的参考传感器和双流系统进行的。另外，分析仪在体内进行了测试。在临床上相关的湿度值范围（5-42 mg H2O / l空气）中，传感器输出与参考传感器读数高度相关（R2> 0.99）。 1-1 / e响应时间均<0.5 s。首次体内试点测量成功。新开发的，经过验证的，快速响应的ACE适用于喉切除术后气道气候评估。

BACKGROUND & AIMS: BACKGROUND:The WHO Director-General has issued a call for action to eliminate cervical cancer as a public health problem. To help inform global efforts, we modelled potential human papillomavirus (HPV) vaccination and cervical screening scenarios in low-income and lower-middle-income countries (LMICs) to examine the feasibility and timing of elimination at different thresholds, and to estimate the number of cervical cancer cases averted on the path to elimination. METHODS:The WHO Cervical Cancer Elimination Modelling Consortium (CCEMC), which consists of three independent transmission-dynamic models identified by WHO according to predefined criteria, projected reductions in cervical cancer incidence over time in 78 LMICs for three standardised base-case scenarios: girls-only vaccination; girls-only vaccination and once-lifetime screening; and girls-only vaccination and twice-lifetime screening. Girls were vaccinated at age 9 years (with a catch-up to age 14 years), assuming 90% coverage and 100% lifetime protection against HPV types 16, 18, 31, 33, 45, 52, and 58. Cervical screening involved HPV testing once or twice per lifetime at ages 35 years and 45 years, with uptake increasing from 45% (2023) to 90% (2045 onwards). The elimination thresholds examined were an average age-standardised cervical cancer incidence of four or fewer cases per 100 000 women-years and ten or fewer cases per 100 000 women-years, and an 85% or greater reduction in incidence. Sensitivity analyses were done, varying vaccination and screening strategies and assumptions. We summarised results using the median (range) of model predictions. FINDINGS:Girls-only HPV vaccination was predicted to reduce the median age-standardised cervical cancer incidence in LMICs from 19·8 (range 19·4-19·8) to 2·1 (2·0-2·6) cases per 100 000 women-years over the next century (89·4% [86·2-90·1] reduction), and to avert 61·0 million (60·5-63·0) cases during this period. Adding twice-lifetime screening reduced the incidence to 0·7 (0·6-1·6) cases per 100 000 women-years (96·7% [91·3-96·7] reduction) and averted an extra 12·1 million (9·5-13·7) cases. Girls-only vaccination was predicted to result in elimination in 60% (58-65) of LMICs based on the threshold of four or fewer cases per 100 000 women-years, in 99% (89-100) of LMICs based on the threshold of ten or fewer cases per 100 000 women-years, and in 87% (37-99) of LMICs based on the 85% or greater reduction threshold. When adding twice-lifetime screening, 100% (71-100) of LMICs reached elimination for all three thresholds. In regions in which all countries can achieve cervical cancer elimination with girls-only vaccination, elimination could occur between 2059 and 2102, depending on the threshold and region. Introducing twice-lifetime screening accelerated elimination by 11-31 years. Long-term vaccine protection was required for elimination. INTERPRETATION:Predictions were consistent across our three models and suggest that high HPV vaccination coverage of girls can lead to cervical cancer elimination in most LMICs by the end of the century. Screening with high uptake will expedite reductions and will be necessary to eliminate cervical cancer in countries with the highest burden. FUNDING:WHO, UNDP, UN Population Fund, UNICEF-WHO-World Bank Special Program of Research, Development and Research Training in Human Reproduction, Canadian Institute of Health Research, Fonds de recherche du Québec-Santé, Compute Canada, National Health and Medical Research Council Australia Centre for Research Excellence in Cervical Cancer Control.

背景与目标： 背景：世界卫生组织总干事已发出呼吁采取行动消除宫颈癌这一公共卫生问题。为帮助全球做出努力，我们对低收入和中低收入国家（LMIC）中潜在的人乳头瘤病毒（HPV）疫苗接种和宫颈筛查方案进行了建模，以研究在不同阈值处进行消除的可行性和时机，并估计数量子宫颈癌病例避免在消除的道路上。
方法：WHO子宫颈癌消除建模协会（CCEMC）由WHO根据预先定义的标准确定的三个独立的传播动力学模型组成，预计在三种标准化的基本情况下，随着时间的推移，78个LMIC的子宫颈癌发病率将降低。 -仅接种疫苗；仅限女孩的疫苗接种和终生筛查；以及仅限女孩的疫苗接种和终生两次筛查。假定90％的覆盖率和100％的人乳头瘤病毒类型16、18、31、33、45、52和58的终生防护能力，女孩在9岁时接种疫苗（到14岁为止）。宫颈癌筛查涉及HPV在35岁和45岁的年龄段中，一生进行一次或两次测试，摄取率从45％（2023）增加到90％（2045起）。检查的消除阈值是按年龄标准化的子宫颈癌的平均发病率，每10万名女性-年不超过4例，每10万名女性-年不超过10例，且发病率降低85％或以上。进行了敏感性分析，改变了疫苗接种，筛查策略和假设。我们使用模型预测的中位数（范围）来汇总结果。
结果：仅女孩HPV疫苗接种预计将使中低收入国家的年龄标准化宫颈癌发病率中位数从19·8（19·4-19·8）降低到每人2·1（2·0-2·6）例到下个世纪，将有10万妇女年（减少89·4％[86·2-90·1]），并在此期间避免6100万（60·5-63·0）例。进行两次终生筛查可将发病率降至每100 000妇女年0·7（0·6-1·6）例（减少96·7％[91·3-96·7]），避免额外的12· 1百万（9·5-13·7）例。根据每100 000妇女年中有四个或更少病例的阈值，预计仅女孩的疫苗接种将导致60％（58-65）的LMIC消除，基于阈值的99％（89-100）个LMIC的消除每100 000名妇女年中有10例或更少的病例，以及基于85％或更高的降低阈值的87％（37-99）的中低收入国家。当添加两次寿命筛查时，所有三个阈值的LMIC均达到100％（71-100）。在所有国家都可以通过仅通过女孩接种疫苗消除子宫颈癌的地区中，根除阈值和地区的不同，消除可能发生在2059年至2102年之间。引入两次终生筛选可将淘汰时间提高11-31年。需要长期的疫苗保护才能消除。
解释：在我们的三个模型中，预测是一致的，这表明到本世纪末，大多数女孩的HPV疫苗接种覆盖率较高，可以消除子宫颈癌。高摄入量的筛查将加快减少筛查的速度，这对于消除负担最重的国家的子宫颈癌必不可少。
资金：卫生组织，开发计划署，联合国人口基金，儿童基金会-卫生组织-世界银行关于人类生殖的研究，发展和研究培训特别方案，加拿大卫生研究所，魁北克省桑德基金会，加拿大计算，国家卫生和医疗研究委员会澳大利亚宫颈癌控制研究卓越中心。

BACKGROUND & AIMS: BACKGROUND:Cardiovascular diseases (CVD) are the leading causes of death for men and women in low-and-middle income countries (LMIC). The nutrition transition to diets high in salt, fat and sugar and low in fruit and vegetables, in parallel with increasing prevalence of diet-related CVD risk factors in LMICs, identifies the need for urgent action to reverse this trend. To aid identification of the most effective interventions it is crucial to understand whether there are sex differences in dietary behaviours related to CVD risk. METHODS:From a dataset of 46 nationally representative surveys, we included data from seven countries that had recorded the same dietary behaviour measurements in adults; Bhutan, Eswatini, Georgia, Guyana, Kenya, Nepal and St Vincent and the Grenadines (2013-2017). Three dietary behaviours were investigated: positive salt use behaviour (SUB), meeting fruit and vegetable (F&V) recommendations and use of vegetable oil rather than animal fats in cooking. Generalized linear models were used to investigate the association between dietary behaviours and waist circumference (WC) and undiagnosed and diagnosed hypertension and diabetes. Interaction terms between sex and dietary behaviour were added to test for sex differences. RESULTS:Twenty-four thousand three hundred thirty-two participants were included. More females than males reported positive SUB (31.3 vs. 27.2% p-value < 0.001), yet less met F&V recommendations (13.2 vs. 14.8%, p-value< 0.05). The prevalence of reporting all three dietary behaviours in a positive manner was 2.7%, varying by country, but not sex. Poor SUB was associated with a higher prevalence of undiagnosed hypertension for females (13.1% vs. 9.9%, p-value = 0.04), and a higher prevalence of undiagnosed diabetes for males (2.4% vs. 1.5%, p-value = 0.02). Meeting F&V recommendations was associated with a higher prevalence of high WC (24.4% vs 22.6%, p-value = 0.01), but was not associated with undiagnosed or diagnosed hypertension or diabetes. CONCLUSION:Interventions to increase F&V intake and positive SUBs in the included countries are urgently needed. Dietary behaviours were not notably different between sexes. However, our findings were limited by the small proportion of the population reporting positive dietary behaviours, and further research is required to understand whether associations with CVD risk factors and interactions by sex would change as the prevalence of positive behaviours increases.

背景与目标： 背景：心血管疾病（CVD）是中低收入国家（LMIC）男女死亡的主要原因。营养向低盐，高脂肪和高糖，低水果和蔬菜的饮食过渡，同时在低收入和中低收入国家中饮食相关的CVD危险因素的患病率上升，这表明需要采取紧急措施来扭转这一趋势。为了帮助确定最有效的干预措施，至关重要的是要了解与CVD风险相关的饮食行为是否存在性别差异。
方法：从46个国家代表性调查的数据集中，我们纳入了七个国家的数据，这些国家记录了成年人的饮食行为测量值；不丹，埃斯瓦蒂尼，格鲁吉亚，圭亚那，肯尼亚，尼泊尔和圣文森特和格林纳丁斯（2013-2017）。调查了三种饮食行为：积极的食盐使用行为（SUB），符合水果和蔬菜（F＆V）的建议以及在烹饪中使用植物油而非动物脂肪。使用广义线性模型研究饮食行为和腰围（WC）与未诊断和诊断的高血压和糖尿病之间的关联。性别与饮食行为之间的相互作用被添加到性别差异测试中。
结果：24,323位参与者被纳入研究。 SUB阳性的女性多于男性（31.3 vs. 27.2％p值<0.001），但满足F＆V建议的人数较少（13.2 vs. 14.8％，p值<0.05）。以积极的方式报告这三种饮食行为的患病率为2.7％，因国家/地区而异，但没有性别差异。 SUB差与女性未确诊高血压的患病率较高（13.1％vs. 9.9％，p值= 0.04）以及男性未诊断糖尿病的患病率较高（2.4％vs. 1.5％，p值= 0.02）有关）。达到F＆V建议与高WC患病率较高相关（24.4％比22.6％，p值= 0.01），但与未被诊断或诊断的高血压或糖尿病无关。
结论：迫切需要采取干预措施以增加所涉国家的F＆V摄入量和阳性SUB。饮食行为在两性之间没有显着差异。但是，我们的研究结果受到少数饮食活动呈阳性的人群的限制，因此，需要进行进一步的研究以了解与CVD危险因素和性别相互作用的关联是否会随着积极行为的普及而改变。

BACKGROUND & AIMS: :The World Health Organization and other institutions are considering Artificial Intelligence (AI) as a technology that can potentially address some health system gaps, especially the reduction of global health inequalities in low- and middle-income countries (LMICs). However, because most AI-based health applications are developed and implemented in high-income countries, their use in LMICs contexts is recent and there is a lack of robust local evaluations to guide decision-making in low-resource settings. After discussing the potential benefits as well as the risks and challenges raised by AI-based health care, we propose five building blocks to guide the development and implementation of more responsible, sustainable, and inclusive AI health care technologies in LMICs.

背景与目标： ：世界卫生组织和其他机构正在考虑将人工智能（AI）作为一种可以解决某些卫生系统差距的技术，尤其是减少中低收入国家（LMIC）的全球卫生不平等现象。但是，由于大多数基于AI的健康应用程序都是在高收入国家开发和实施的，因此它们在LMIC中的应用是最近的，并且缺乏强有力的本地评估来指导在资源贫乏地区的决策。在讨论了基于AI的医疗保健的潜在利益以及所带来的风险和挑战之后，我们提出了五个构建模块，以指导在中低收入国家中更负责任，可持续和包容性更高的AI医疗技术的开发和实施。

BACKGROUND & AIMS: :An amendment to this paper has been published and can be accessed via a link at the top of the paper.

背景与目标： ：已经发布了对本文的修订，可以通过本文顶部的链接进行访问。

BACKGROUND & AIMS: :Genetic diversities of Douglas-fir provenance trials planted on several European sites were compared using both isozyme and terpene markers. A principal coordinate analysis based on similarity coefficients calculated from isozyme data indicated that, with the exception of two populations, differences between populations were small. There were no consistent trends in the variation in allele frequencies between populations. Most populations contained an excess of homozygotes, perhaps due to high selection pressure. Terpene composition was analysed in two resin systems, and showed a decreasing level of population diversity by planting site in the order: Spain-France-England-Scotland-Italy. Thus isozymes, which are generally considered to be neutral markers, indicated a modest degree of genetic drift due to sampling effects, while terpenes showed that some reduction in genetic diversity had occurred due to local selective pressures.

背景与目标： ：使用同工酶和萜烯标记比较了在欧洲多个地点种植的道格拉斯冷杉起源试验的遗传多样性。基于同工酶数据计算的相似系数的主坐标分析表明，除两个种群外，种群之间的差异很小。人群之间等位基因频率的变化没有一致的趋势。大多数种群可能含有过量的纯合子，这可能是由于较高的选择压力所致。在两个树脂系统中分析了萜烯的组成，并按种植地的顺序显示了种群减少的程度：西班牙-法国-英格兰-苏格兰-意大利。因此，通常被认为是中性标记的同工酶由于采样效应而显示出适度的遗传漂移，而萜烯表明由于局部选择压力而导致了遗传多样性的某种程度的降低。