CHOICE-OF-COURT AGREEMENTS IN COMMERCIAL, FAMILY AND SUCCESSION MATTERS

Choice-of-court agreements reduce a legal uncertainty regarding which State may hear a dispute and whether the judgement of the court will be upheld in other countries since this planning tool enables the parties to predict the venue for the dispute. The PhD project aims at examining rules on choice-of-court agreements in the EU in civil and commercial matters (under the Brussels Ibis Regulation, Hague Convention on Choice of Court Agreements, the 2007 Lugano Convention), in family matters (under the Brussels IIa Regulation, Maintenance Regulation, Matrimonial Property Regime Regulation, Regulation on the Property Consequences of Registered Partnerships), and in succession matters (under the Succession Regulation). Moreover, this project makes an effort in identifying the barriers, weaknesses, and gaps of the rules on choice-of-court agreements, lis pendens, and parallel proceedings, it proposes solutions de lege ferenda and it examines the interplay of the legal instruments through their simultaneous application. This thesis is divided into three chapters. The first chapter introduces party autonomy on a general level, which includes the outline of different categorizations of party autonomy, a brief historical development of the choice-of-court agreements and the analysis of the nature and effect of the choice-of-court agreement. This chapter focuses on the importance of the rules on choice-of-court agreements in the EU, their functions, and practical use, as well as divergent limitations with respect to choice-of-court agreements. The second chapter represents a core of the PhD thesis tackling the civil and commercial matters: it analyzes choice-of-court agreements (scope, conditions for applications, formal and substantive validity, exclusivity, severability) and issues related to it (rules on lis pendens and on parallel proceedings) under the Brussels and Lugano Regimes, under the Hague Convention on Choice of Court Agreement and it examines the interplay between all these three legal instruments in the practical examples. The third and last part deals with the choice-of-court agreements in family and succession matters, which is further broken down by the single EU Regulations. In particular, this last chapter pays attention to: Article 12 of the Brussels IIa Regulation, which determines the rule on prorogation of jurisdiction in parental responsibility matters; lacking rule on choice-of-court in divorce under the Brussels IIa Regulation; Article 4 of the Maintenance Regulation, which determines the rule on choice-of-court agreements in maintenance matters; Articles 5 and 7 of the Regulation on Matrimonial Property Regimes and the Regulation on Property Consequences of Registered Partnerships, which determine the rules on choice-of-court agreements in property regimes of the spouses and registered partners; Articles 5, 6, 7, and 9 of the Succession Regulation allowing party autonomy to a limited extent

Reconstructing neural circuits using multiresolution correlated light and electron microscopy

Correlated light and electron microscopy (CLEM) can be used to combine functional and molecular characterizations of neurons with detailed anatomical maps of their synaptic organization. Here we describe a multiresolution approach to CLEM (mrCLEM) that efficiently targets electron microscopy (EM) imaging to optically characterized cells while maintaining optimal tissue preparation for high-throughput EM reconstruction. This approach hinges on the ease with which arrays of sections collected on a solid substrate can be repeatedly imaged at different scales using scanning electron microscopy. We match this multiresolution EM imaging with multiresolution confocal mapping of the aldehyde-fixed tissue. Features visible in lower resolution EM correspond well to features visible in densely labeled optical maps of fixed tissue. Iterative feature matching, starting with gross anatomical correspondences and ending with subcellular structure, can then be used to target high-resolution EM image acquisition and annotation to cells of interest. To demonstrate this technique and range of images used to link live optical imaging to EM reconstructions, we provide a walkthrough of a mouse retinal light to EM experiment as well as some examples from mouse brain slices

A survey of UK medical schools' arrangements for early patient contact

Background: Many U.K. medical schools have patient contact in the first two years of the undergraduate course. Aim: To compare the purposes and organization of early patient contact in UK medical schools and to relate these arrangements to the schools' curricular objectives. Methods: A telephone survey of lead educators in UK medicals schools. Categories of contact were plotted against phases of the course to discern patterns of organisation. Results: The quantity of contact varies considerably (four to 65 days). There is a pattern, with learning objectives around the social context of health and illness preceding skills based work and integrated clinical knowledge for practice coming later. Schools fall into three categories: close adherence to the preclinical/clinical split, with limited early contact acting as an introduction to social aspects of health; provision of substantial patient contact to maximize the integration of knowledge and skills; and transitional, with limited clinical goals. General practice provides between one third and one half of early patient contact. Conclusions: Arrangements meet the objectives set by each school and reflect differing educational philosophies. Change is toward more early contact. There appears to be no national guidance which supports a minimum quantity of patient contact or specific educational purpose in the early years of U.K. basic medical training

Doctor-patient interaction in Finnish primary health care as perceived by first year medical students

BACKGROUND: In Finland, public health care is the responsibility of primary health care centres, which render a wide range of community level preventive, curative and rehabilitative medical care. Since 1990's, medical studies have involved early familiarization of medical students with general practice from the beginning of the studies, as this pre-clinical familiarisation helps medical students understand patients as human beings, recognise the importance of the doctor-patient relationship and identify practicing general practitioners (GPs) as role models for their professional development. Focused on doctor-patient relationship, we analysed the reports of 2002 first year medical students in the University of Kuopio. The students observed GPs' work during their 2-day visit to primary health care centres. METHODS: We analysed systematically the texts of 127 written reports of 2002, which represents 95.5% of the 133 first year pre-clinical medical students reports. The reports of 2003 (N = 118) and 2004 (N = 130) were used as reference material. RESULTS: Majority of the students reported GPs as positive role models. Some students reported GPs' poor attitudes, which they, however, regarded as a learning opportunity. Students generally observed a great variety of responsibilities in general practice, and expressed admiration for the skills and abilities required. They appreciated the GPs' interest in patients concerns. GPs' communication styles were found to vary considerably. Students reported some factors disturbing the consultation session, such as the GP staring at the computer screen and other team members entering the room. Working with marginalized groups, the chronically and terminally ill, and dying patients was seen as an area for development in the busy Finnish primary health care centres. CONCLUSION: During the analysis, we discovered that medical students' perceptions in this study are in line with the previous findings about the importance of role model (good or bad) in making good doctors. Therefore, medical students' pre-clinical primary health care centre visits may influence their attitudes towards primary health care work and the doctor-patient relationship. We welcome more European studies on the role of early pre-clinical general practice exposure on medical students' primary care specialty choice

Minimal residual disease prior to allogeneic hematopoietic cell transplantation in acute myeloid leukemia: a meta-analysis

Minimal residual disease prior to allogeneic hematopoietic cell transplantation has been associated with increased risk of relapse and death in patients with acute myeloid leukemia, but detection methodologies and results vary widely. We performed a systematic review and meta-analysis evaluating the prognostic role of minimal residual disease detected by polymerase chain reaction or multiparametric flow cytometry before transplant. We identified 19 articles published between January 2005 and June 2016 and extracted hazard ratios for leukemia-free survival, overall survival, and cumulative incidences of relapse and non-relapse mortality. Pre-transplant minimal residual disease was associated with worse leukemia-free survival (HR=2.76 [1.90-4.00]), overall survival (HR=2.36 [1.73-3.22]), and cumulative incidence of relapse (HR=3.65 [2.53-5.27]), but not non-relapse mortality (HR=1.12 [0.81-1.55]). These associations held regardless of detection method, conditioning intensity, and patient age. Adverse cytogenetics was not an independent risk factor for death or relapse. There was more heterogeneity among studies using flow cytometry-based than WT1 polymerase chain reaction-based detection (I(2)=75.1% vs. <0.1% for leukemia-free survival, 67.8% vs. <0.1% for overall survival, and 22.1% vs. <0.1% for cumulative incidence of relapse). These results demonstrate a strong relationship between pre-transplant minimal residual disease and post-transplant relapse and survival. Outcome heterogeneity among studies using flow-based methods may underscore site-specific methodological differences or differences in test performance and interpretation

A systematic review of natural health product treatment for vitiligo

<p>Abstract</p> <p>Background</p> <p>Vitiligo is a hypopigmentation disorder affecting 1 to 4% of the world population. Fifty percent of cases appear before the age of 20 years old, and the disfigurement results in psychiatric morbidity in 16 to 35% of those affected.</p> <p>Methods</p> <p>Our objective was to complete a comprehensive, systematic review of the published scientific literature to identify natural health products (NHP) such as vitamins, herbs and other supplements that may have efficacy in the treatment of vitiligo. We searched eight databases including MEDLINE and EMBASE for vitiligo, leucoderma, and various NHP terms. Prospective controlled clinical human trials were identified and assessed for quality.</p> <p>Results</p> <p>Fifteen clinical trials were identified, and organized into four categories based on the NHP used for treatment. 1) L-phenylalanine monotherapy was assessed in one trial, and as an adjuvant to phototherapy in three trials. All reported beneficial effects. 2) Three clinical trials utilized different traditional Chinese medicine products. Although each traditional Chinese medicine trial reported benefit in the active groups, the quality of the trials was poor. 3) Six trials investigated the use of plants in the treatment of vitiligo, four using plants as photosensitizing agents. The studies provide weak evidence that photosensitizing plants can be effective in conjunction with phototherapy, and moderate evidence that <it>Ginkgo biloba </it>monotherapy can be useful for vitiligo. 4) Two clinical trials investigated the use of vitamins in the therapy of vitiligo. One tested oral cobalamin with folic acid, and found no significant improvement over control. Another trial combined vitamin E with phototherapy and reported significantly better repigmentation over phototherapy only. It was not possible to pool the data from any studies for meta-analytic purposes due to the wide difference in outcome measures and poor quality ofreporting.</p> <p>Conclusion</p> <p>Reports investigating the efficacy of NHPs for vitiligo exist, but are of poor methodological quality and contain significant reporting flaws. L-phenylalanine used with phototherapy, and oral <it>Ginkgo biloba </it>as monotherapy show promise and warrant further investigation.</p

СОВРЕМЕННАЯ ЛУЧЕВАЯ ТЕРАПИЯ ЖЕЛУДКА

External beam radiation therapy (EBRT) is currently an important component of the treatment of gastric cancer (GC). In accordance with international and domestic recommendations, it can be used in the postoperative period, before the operation and as a sole option, with a curative and palliative purpose, usually in combination with chemotherapy. With the transition of RT to a new technological level, which involves the use of conformal, intensively modulated regimens, and image guidance the revision of indications for and doses of EBRT is required. The article discusses modern approaches to the determination of irradiated volumes in various clinical scenarios of current radiation therapy for GC and strategies aimed at reducing the dose in critical organs at risk and increasing the overall effectiveness of treatment.Дистанционная лучевая терапия (ЛТ) в настоящее время является важным компонентом лечения рака желудка (РЖ). В соответствии с международными и отечественными рекомендациями она может быть использована в послеоперационном периоде, перед операцией и самостоятельно, с лечебной и паллиативной целью, как правило, в сочетании с химиотерапией. В связи с переходом ЛТ на новый технологический уровень, предусматривающий использование конформных, интенсивно-модулированных режимов, требуется пересмотр показаний, доз и режимов дистанционного облучения. В статье рассмотрены современные подходы к определению облучаемых объемов при различных клинических сценариях современной ЛТ по поводу РЖ и обсуждены стратегии, направленные на снижение дозы в критических органах и повышение эффективности лечения

Medical students' and facilitators' experiences of an Early Professional Contact course: Active and motivated students, strained facilitators

Background: Today, medical students are introduced to patient contact, communication skills, and clinical examination in the preclinical years of the curriculum with the purpose of gaining clinical experience. These courses are often evaluated from the student perspective. Reports with an additional emphasis on the facilitator perspective are scarce. According to constructive alignment, an influential concept from research in higher education, the learning climate between students and teachers is also of great importance. In this paper, we approach the learning climate by studying both students' and facilitators' course experiences.\ud \ud In 2001, a new "Early Professional Contact" longitudinal strand through term 1–4, was introduced at the Sahlgrenska Academy, University of Gothenburg, Sweden. General practitioners and hospital specialists were facilitators.\ud \ud The aim of this study was to assess and analyse students' and clinical facilitators' experiences of the Early Professional Contact course and to illuminate facilitators' working conditions.\ud \ud Methods: Inspired by a Swedish adaptation of the Course Experience Questionnaire, an Early Professional Contact Questionnaire was constructed. In 2003, on the completion of the first longitudinal strand, a student and facilitator version was distributed to 86 students and 21 facilitators. In the analysis, both Chi-square and the Mann-Whitney tests were used.\ud \ud Results: Sixty students (70%) and 15 facilitators (71%) completed the questionnaire. Both students and facilitators were satisfied with the course. Students reported gaining [inspiration] for their future work as doctors along with increased confidence in meeting patients. They also reported increased motivation for biomedical studies. Differences in attitudes between facilitators and students were found. Facilitators experienced a greater workload, less reasonable demands and less support, than students.\ud \ud Conclusion: In this project, a new Early Professional Contact course was analysed from both student and facilitator perspectives. The students experienced the course as providing them with a valuable introduction to the physician's professional role in clinical practice. In contrast, course facilitators often experienced a heavy workload and lack of support, despite thorough preparatory education. A possible conflict between the clinical facilitator's task as educator and member of the workplace is suggested. More research is needed on how doctors combine their professional tasks with work as facilitators

A destabilized bacterial luciferase for dynamic gene expression studies

Fusions of genetic regulatory elements with reporter genes have long been used as tools for monitoring gene expression and have become a major component in synthetic gene circuit implementation. A major limitation of many of these systems is the relatively long half-life of the reporter protein(s), which prevents monitoring both the initiation and the termination of transcription in real-time. Furthermore, when used as components in synthetic gene circuits, the long time constants associated with reporter protein decay may significantly degrade circuit performance. In this study, short half-life variants of LuxA and LuxB from Photorhabdus luminescens were constructed in Escherichia coli by inclusion of an 11-amino acid carboxy-terminal tag that is recognized by endogenous tail-specific proteases. Results indicated that the addition of the C-terminal tag affected the functional half-life of the holoenzyme when the tag was added to luxA or to both luxA and luxB, but modification of luxB alone did not have a significant effect. In addition, it was also found that alteration of the terminal three amino acid residues of the carboxy-terminal tag fused to LuxA generated variants with half-lives of intermediate length in a manner similar to that reported for GFP. This report is the first instance of the C-terminal tagging approach for the regulation of protein half-life to be applied to an enzyme or monomer of a multi-subunit enzyme complex and will extend the utility of the bacterial luciferase reporter genes for the monitoring of dynamic changes in gene expression

Влияние пандемии COVID-19 на показатели заболеваемости злокачественными опухолями, подлежащими скринингу в рамках диспансеризации (популяционное исследование)

Background. During the COVID-19 pandemic, annual adult check-ups have been postponed, resulting in cancer screening disruption.The aim of the study was to evaluate changes in the incidence and stage distribution of malignancies included in the screening program during the COVID-19 pandemic using the Arkhangelsk Regional Cancer Registry (ARRC).Material and Methods. We assessed the changes of the incidence rates and stage distribution for the colon, rectum, lung, breast, cervix, uterine body, ovary, prostate and kidney cancers over the periods 2018–19 and 2020–21. Results. A total of 12354 cases with 9 cancers were selected: 6680 for the period 2018–19 and 5674 (-15.1 %) for the period 2020-21. The most significant decrease in crude and age-standardized incidence rates was registered in patients with lung (-18.0–18.1 %), rectum (-25.1–25.9 %) and cervix (-33.6–36.9 %) cancers, p&lt;0.001. The decrease was not signifcant in patients with breast, uterine body, and kidney cancers. The proportion of patients with stage I decreased in lung cancer (-20.0 %, from 14.8 % to 11.8 %), rectum (-20.2 %, from 20.9 % to 16.7 %), and uterine cervix (-37.1 %, from 53.2 % to 33.5 %). In prostate and kidney cancers, the proportion of patients with stage I increased by 30 % (from 19.5 % to 25.4 %) and 17.6 % (from 45.9 % to 54.0 %), respectively. A signifcant reduction in the proportion of early stages during the COVID-19 pandemic was observed in lung and cervical cancer. Conclusion Postponed health checkups due to COVID-19 pandemic disruptions have led to substantial reductions in new cancers being diagnosed, mainly for cervical, lung, colon and rectal cancers. No signifcant changes were observed for other cancers. Further analysis of mortality and survival of cancer patients is required. Key words: health checkup, cancer screening, COVID-19 pandemic, cancer incidence, stage distribution&gt;˂0.001. The decrease was not significant in patients with breast, uterine body, and kidney cancers. The proportion of patients with stage I decreased in lung cancer (-20.0 %, from 14.8 % to 11.8 %), rectum (-20.2 %, from 20.9 % to 16.7 %), and uterine cervix (-37.1 %, from 53.2 % to 33.5 %). In prostate and kidney cancers, the proportion of patients with stage I increased by 30 % (from 19.5 % to 25.4 %) and 17.6 % (from 45.9 % to 54.0 %), respectively. A significant reduction in the proportion of early stages during the COVID-19 pandemic was observed in lung and cervical cancer.Conclusion. Postponed health checkups due to COVID-19 pandemic disruptions have led to substantial reductions in new cancers being diagnosed, mainly for cervical, lung, colon and rectal cancers. No significant changes were observed for other cancers. Further analysis of mortality and survival of cancer patients is required. Актуальность. В период пандемии COVID-19 была приостановлена диспансеризация отдельных групп взрослого населения (ДОГВН), что могло привести к ухудшению скрининга ряда злокачественных новообразований (ЗНО).Цель исследования ‒ оценить изменения заболеваемости и стадийной структуры ЗНО, включенных в программу скрининга в рамках ДОГВН, во время пандемии COVID-19 по данным Архангельского областного канцер-регистра (АОКР).Материал и методы. Оценивали динамику показателей заболеваемости и распределения по стадии при индексных ЗНО (иЗНО) ободочной, прямой кишки, легкого, молочной железы, шейки, тела матки, яичников, предстательной железы и почки в периоды 2018–19 гг. и 2020–21 гг.Результаты. Всего отобрано 12354 случая заболевания при девяти иЗНО: в 2018–19 гг. выявлено 6680, в 2020–21 гг. – 5674 (-15,1 %). Наиболее выраженное снижение «грубых» и стандартизованных по возрасту показателей заболеваемости зарегистрировано при раке легкого (-18,0–18,1 %), прямой кишки (-25,1–25,9 %) и шейки матки (-33,6–36,9 %), различия статистически значимы (р&lt;0,001). Снижение было статистически незначимым при раке молочной железы, тела матки, почки. Доля больных I стадии уменьшалась при раке легкого (на 20,0 %, с 14,8 до 11,8 %), прямой кишки (на 20,2 %, с 20,9 до 16,7 %), шейки матки (на 37,1 %, с 53,2 до 33,5 %). При раке предстательной железы и почки зарегистрировано увеличение доли I стадии на 30 % (с 19,5 до 25,4 %) и 17,6 % (с 45,9 до 54,0 %) соответственно. В возрастных группах скрининга в рамках ДОГВН значимое снижение доли ранних стадий в период пандемии COVID-19 наблюдали при раке легкого и шейки матки. Заключение. Ограничение ДОГВН в период пандемии привело к уменьшению числа выявленных иЗНО в основном за счет ранних стадий при раке шейки матки, легкого, ободочной и прямой кишки. При других иЗНО эти изменения были не столь явными. В дальнейшем требуется анализ смертности и выживаемости больных иЗНО. Ключевые слова: диспансеризация взрослого населения, скрининг рака, индексные злокачественные новообразования, пандемия COVID-19, заболеваемость, распределение по стадии.&gt;˂ 0,001). Снижение было статистически незначимым при раке молочной железы, тела матки, почки. Доля больных I стадии уменьшалась при раке легкого (на 20,0 %, с 14,8 до 11,8 %), прямой кишки (на 20,2 %, с 20,9 до 16,7 %), шейки матки (на 37,1 %, с 53,2 до 33,5 %). При раке предстательной железы и почки зарегистрировано увеличение доли I стадии на 30 % (с 19,5 до 25,4 %) и 17,6 % (с 45,9 до 54,0 %) соответственно. В возрастных группах скрининга в рамках ДОГВН значимое снижение доли ранних стадий в период пандемии COVID-19 наблюдали при раке легкого и шейки матки.Заключение. Ограничение ДОГВН в период пандемии привело к уменьшению числа выявленных иЗНО в основном за счет ранних стадий при раке шейки матки, легкого, ободочной и прямой кишки. При других иЗНО эти изменения были не столь явными. В дальнейшем требуется анализ смертности и выживаемости больных иЗНО.