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PURPOSE OF REVIEW: Medical cannabis (MC) has entered mainstream medicine by a unique route. Regulatory acceptance as a medical product in many jurisdictions has bypassed the traditional evidence-based pathway required for therapies. Easier access to MC, especially related to recreational legalization of cannabis, has led to widespread use by patients for symptom relief of a variety of medical conditions and often without medical oversight. Musculoskeletal pain remains the most common reason for MC use. This review examines real-world issues pertaining to MC and offers some guidance for clinical care of patients with rheumatic diseases being treated with MC. RECENT FINDINGS: Controlled clinical studies of cannabis products in patients with rheumatic diseases have been small and tested a range of compounds, routes of administration, and clinical populations, limiting our ability to generate conclusions on MC's effectiveness in this population. Observational cohort studies and surveys suggest that use of MC and related products in patients with rheumatic diseases improves pain and associated symptoms but is commonly accompanied by mild to moderate side effects. Conflicting evidence contributes to practitioner and patient uncertainty regarding the use of MC for rheumatic disease-related pain. Despite promising preclinical and observational evidence that MC and cannabis-derived compounds are useful in the management of rheumatic disease-related pain, there remains limited high-quality clinical evidence to substantiate these findings. There are a significant number of clinical trials on this topic currently planned or underway, however, suggesting the next decade may yield more clarity. Nevertheless, given that many people with rheumatic diseases are using cannabis products, healthcare professionals must remain apprised of the evidence pertaining to cannabinoids, communicate such evidence to patients in a meaningful way that is free from personal bias and stigma, and maintain strong collaborative clinical care pertaining to MC.
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BACKGROUND: The Masterplan Medicine 2020 adopted in 2017 entails many changes to the medical studies curriculum. The new structure affects the content of the coursework and its main focus. A major goal of this masterplan is to prepare young physicians by teaching the skills that are essential for the future profession. The National Competence-Based Learning Objectives Catalog for Medicine (NKLM) provides the basis for the teaching content. METHODS: The Working Group Teaching of the German Society of Ophthalmology (Arbeitsgemeinschaft Lehre der DOG) actively supports this transformation. In cross-site collaboration, teaching materials for various teaching formats have been compiled by relying on the NKLM (e.g., recordings of operations, slides for small group instruction, image galleries, case studies). An online library named the DOG-EyeTeacher was then created. RESULTS: The aim of the DOG-EyeTeacher is to relieve the training clinics and to establish basic standards in teaching materials, thereby enabling the necessary focus on medical education. The provision of these teaching materials should deepen the interest in ophthalmology among future doctors. CONCLUSION: The DOG-EyeTeacher is our response to the challenges associated with the planned restructuring of the medical curriculum. Since October 2023, any DOG member involved in teaching can create an account free of charge to use our materials.
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BACKGROUND: Policies governing legal cannabis commerce can vary widely within a U.S. state when local control exists. Disproportionate distribution of policies allowing retail sale, protecting public health, or promoting equity in licensing may contribute to differences in health and economic outcomes between sociodemographic subgroups. This cross-sectional study jointly examined racial, ethnic, and neighborhood socioeconomic characteristics of Californians subject to specific local cannabis policies to identify such disparities. METHODS: Local laws in effect January 1, 2020, governing retail cannabis sales (bans, expanding buffers from youth-serving sites, restricting advertising, promoting equity in licensing, and capping outlets) were determined for California's 539 jurisdictions. The number of Asian, Black, Latinx, and white residents in socioeconomic advantaged versus disadvantaged neighborhoods (Census block groups) was determined using 2015-2019 American Community Survey data. We estimated proportions of the sociodemographic subpopulations covered by specific policies based on the block group's jurisdiction. To ascertain disparities in coverage proportions were compared across subgroups using Z-tests with the Bonferroni correction. RESULTS: Residents of socioeconomically advantaged neighborhoods were more likely to live in jurisdictions allowing retail cannabis commerce than those in disadvantaged neighborhoods (61.7 % versus 54.8 %). Black residents in advantaged neighborhoods were most likely to live where retailing was allowed (69 %), and white residents in disadvantaged neighborhoods least likely (49 %). Latinx and Black populations from disadvantaged neighborhoods were most likely to live in jurisdictions with stronger advertising restrictions (66 %). Equity in licensing policy was more prevalent for Black residents living in advantaged neighborhoods (57 %) than disadvantaged neighborhoods (49 %). CONCLUSIONS: Local cannabis policies potentially protecting public health and social equity are unequally distributed across race, ethnicity, and socioeconomic characteristics in California. Research examining whether differential policy exposure reduces, creates, or perpetuates cannabis-related health and socioeconomic disparities is needed.
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Indian biotech startup sector - a rapidly growing business segment focused on the development of innovative products has the potential to make significant contributions to the country's economy. Indian bio-entrepreneurs' optimistic expectation of rapidly moving product development from bench to bedside faces tremendous challenges of the complex Indian regulatory system, which is shaped by a diversity of regulatory authorities, rules, guidelines, and processes. This brief review discusses specific regulatory issues faced by bio-entrepreneurs investing in a variety of innovative products - new drugs, vaccines, medical devices, cell, and gene therapy and suggests approaches which can ease Indian entrepreneur's endeavors.
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Currently, China is at a critical stage of accelerating the green transformation of its economic development model, with considerable attention being paid to achieving this transformation while maintaining moderate economic growth. This study uses 271 prefecture-level cities in China from 2006 to 2020 to examine the impact of local government economic growth target constraints on the level of green economic development and to elucidate the underlying mechanisms. The results show that economic growth targets significantly inhibit the level of urban green development, with this effect being more pronounced in the economically developed eastern regions of China. Hard constraints on economic growth targets have a greater inhibitory effect on green development than soft constraints. The greater the promotion pressure on local officials, the stronger the inhibitory effect of economic growth target constraints on green development. The test of the mediation effect model reveals that economic growth targets can inhibit green development by affecting the degree of regional marketization, leading to mismatches in the capital and labor markets. Moreover, environmental regulations can mitigate the inhibitory effect of economic growth targets on green development levels. The conclusions of this study provide useful insights for local governments to optimize economic development target constraint mechanisms and accelerate high-quality green economic development.
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Pseudomonas aeruginosa has become a top-priority pathogen in the health sector because it is ubiquitous, has high metabolic/genetic versatility, and is identified as an opportunistic pathogen. The production of numerous virulence factors by P. aeruginosa was reported to act individually or cooperatively to make them robots invasion, adherences, persistence, proliferation, and protection against host immune systems. P. aeruginosa produces various kinds of extracellular proteases such as alkaline protease, protease IV, elastase A, elastase B, large protease A, Pseudomonas small protease, P. aeruginosa aminopeptidase, and MucD. These proteases effectively allow the cells to invade and destroy host cells. Thus, inhibiting these protease activities has been recognized as a promising approach to controlling the infection caused by P. aeruginosa. The present review discussed in detail the characteristics of these proteases and their role in infection to the host system. The second part of the review discussed the recent updates on the multiple strategies for attenuating or inhibiting protease activity. These strategies include the application of natural and synthetic molecules, as well as metallic/polymeric nanomaterials. It has also been reported that a propeptide present in the middle domain of protease IV also attenuates the virulence properties and infection ability of P. aeruginosa.
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The coordination of heterogeneous environmental regulations (HER) is crucial for promoting regional green synergistic development. The primary objective of this study is to evaluate the impact of various heterogeneous environmental regulations (HER) on the green economic transformation (GET) of cities in China. We developed a comprehensive index system to measure the GET across three dimensions: the level of economic green development, the capacity for resource and environmental support, and the level of support for green transformation. This study examines 284 Chinese cities during the period from 2011 to 2020. Applying a dynamic panel model, a dynamic Durbin model, and a synergy model, we explore direct effects, spatial effects, and asymmetry of synergistic effects of HER on the GET of Chinese cities. We find that, in terms of direct effects, all environmental regulations can promote urban GET, though the magnitude of effects is heterogeneous. In terms of spatial spillover effects, market-incentive and public-participation environmental policies in a given region inhibit green transformation in neighboring regions, while overall environmental regulation and command-and-control regulation have significant positive effects on neighboring regions' green transformation. Furthermore, the total short-term effect of HER is significantly higher than the total long-term effect. The synergistic effect of HER is positive for the Beijing-Tianjin-Hebei city cluster and the Yangtze River Delta city cluster. This study can provide valuable policy implications for regional coordinated development with a low-carbon focus.
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European manufacturing firms have to cope with the new regulations that advocate a greener and more sustainable future with less emissions and at the same time enhance or at least maintain their productivity levels. A unique dataset is constructed by combining information on different firms' pollutants with their financial information during the 2011-2017 period. A non-radial directional distance function analysis is adopted with desirable and undesirable outputs to estimate environmental productivity growth and its components, which addresses the problem of heterogeneity. A regulatory impact indicator that provides information about the loss of outputs resulting from new policies is also computed. Finally, the impact of environmental regulations on productivity growth is explored using a panel vector autoregressive method. Our findings showcase different average values of productivity for each pollutant group. Moreover, results indicate that increasing the index of regulations by 1%, increases environmental productivity by 0.24% and 0.44% for heavy metals and greenhouse gases groups, respectively. Finally, results support the "weak" Porter Hypothesis, which attests that welldesigned environmental regulations can exert a positive effect on environmental innovation.
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Carbon sequestration is vital to maintaining carbon neutrality and mitigating climate change's impact on humans and the environment. As the government's role in eco-advocacy is primarily designed to safeguard the environment, this paper discusses the impact of government environmental regulations on carbon sequestration. By analyzing Chinese 286 cities from 2010 to 2019, we propose that government environmental regulation can lead to a 0.77% increase in carbon sequestration. Furthermore, industrial agglomeration and improvements in industrial structure are considered feasible pathways. Due to variations in city types, government interventions, and public concerns among different cities, the resulting impact is expected to vary. The government ought to emphasize its regulatory influence in this domain, and furnish cities with overarching policy directives to facilitate carbon sequestration initiatives.
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The use of lead shotgun ammunition for shooting wildfowl has been restricted in England since 1999, but surveys finding lead shot in harvested birds show compliance with regulations has been low. Following the announcement in 2020 of a voluntary transition from lead to non-lead shot by UK shooting organizations, we investigated spatiotemporal variation in the composition of ammunition used for shooting mallards Anas platyrhynchos. We collected 176 harvested mallards during the 2021/22 shooting season and analyzed recent shot extracted from carcasses to determine shot composition. Using a separate collection of ducks of known provenance, we used stable isotope analysis as a means of differentiating captive-reared from wild mallards. This allowed us to understand how compliance might vary between driven game shooters, characterized by shooting birds that are flushed over a stationary line of shooters, and who primarily harvest captive-reared and released ducks, and wild duck shooters. Of 133 mallards containing recent shot, 92 (69%) had been illegally shot with lead. Analysis of this and five comparable surveys between 2001 and 2019 indicates regional and temporal variation in lead shot presence in England. In the North West and West Midlands, the likelihood of mallards containing lead shot decreased significantly over time, but no other regions showed significant changes. The use of non-lead shot types varied over time, with increases in steel shot use approximately matched by declines in bismuth shot. Mallards likely to be reared were more likely to have been shot with lead (75%) than those likely to be wild (48%). This suggests the use of lead shot is more frequent among driven game shooters than wild duck shooters. In England in 2021/22, most mallards continued to be shot with lead, suggesting that neither legislation nor voluntary approaches have been effective in substantially reducing illegal use of lead shot.
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Controls on essential/precursor chemicals from commercial companies have been associated with many large downturns in illicit drug markets and attendant problems. My colleagues and I brought this to light in the studies that are the subject of Giommoni's review. McKetin et al. in an earlier review considered several of our studies on chemical controls for methamphetamine, all centered in North America. Giommoni discusses not only those studies but also our later work on chemical controls for cocaine and heroin. This later work evaluates US essential/precursor chemical policies targeting illicit drug producers outside of North America, and it examines impacts on illicit drug availability and use (the studies reviewed by McKetin et al. predominantly focused on outcomes such as drug-related hospitalizations, arrests, and treatment). Giommoni's review is a new resource that will help make the varied topics in essential/precursor chemical control research more accessible to many readers. After noting this, I discuss some common methodological misconceptions about our studies. For example, our studies generally used multi-replication interrupted time series analysis, a research design among the most powerful of all quasi-experimental designs. Authors, however, typically discuss the studies as if they used single-intervention interrupted time series analysis, a less powerful design. Multi-replication and single-intervention interrupted time series analyses also differ regarding likely confounders; awareness of this is critical to accurately assessing our findings and critiquing alternative explanations. Finally, I note that commercial chemical companies function as the silent, albeit usually unwitting, partners in the large-scale production of several illicit drugs, including fentanyl. And many governments are implementing essential/precursor chemical controls to help stymie this partnership. But they are doing so largely without evaluation and study-a poor policy practice. To remedy this, I suggest establishing multi-disciplinary applied research teams to help assess, guide and improve essential/precursor chemical control efforts.
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BACKGROUND: Assessment of the effective use of international travel measures during the COVID-19 pandemic has focused on public health goals, namely limiting virus introduction and onward transmission. However, risk-based approaches includes the weighing of public health goals against potential social, economic and other secondary impacts. Advancing risk-based approaches thus requires fuller understanding of available evidence on such impacts. METHODS: We conducted a scoping review of existing studies of the social impacts of international travel measures during the COVID-19 pandemic. Applying a standardized typology of travel measures, and five categories of social impact, we searched 9 databases across multiple disciplines spanning public health and the social sciences. We identified 26 studies for inclusion and reviewed their scope, methods, type of travel measure, and social impacts analysed. RESULTS: The studies cover a diverse range of national settings with a strong focus on high-income countries. A broad range of populations are studied, hindered in their outbound or inbound travel. Most studies focus on 2020 when travel restrictions were widely introduced, but limited attention is given to the broader effects of their prolonged use. Studies primarily used qualitative or mixed methods, with adaptations to comply with public health measures. Most studies focused on travel restrictions, as one type of travel measure, often combined with domestic public health measures, making it difficult to determine their specific social impacts. All five categories of social impacts were observed although there was a strong emphasis on negative social impacts including family separation, decreased work opportunities, reduced quality of life, and inability to meet cultural needs. A small number of countries identified positive social impacts such as restored work-life balance and an increase in perceptions of safety and security. CONCLUSIONS: While international travel measures were among the most controversial interventions applied during the COVID-19 pandemic, given their prolonged use and widespread impacts on individuals and populations, there remains limited study of their secondary impacts. If risk-based approaches are to be advanced, involving informed choices between public health and other policy goals, there is a need to better understand such impacts, including their differential impacts across diverse populations and settings.
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COVID-19 , Viagem , Humanos , COVID-19/prevenção & controle , COVID-19/epidemiologia , Internacionalidade , Saúde Pública , PandemiasRESUMO
Background: Laws and regulations are needed to regulate the growing online pharmacy (OP) services. The main objective of this work was to provide an overview of the laws and regulations for OP services in the Gulf Cooperation Council (GCC) countries. In addition, the perception of how these laws and regulations in Saudi Arabia (SA) affect the online ordering of medications and health-related products from national and international OPs was explored. Methods: A secondary data collection through emails and a qualitative descriptive analysis was used to gain insight into the OP regulations in the GCC countries. Then, a qualitative study was carried out with semi-structured interviews to investigate the impact of these regulations on the practice and the market from the OP service providers' perspective. The interviews were carried out with a sample of major OP service providers in SA, to represent the GCC countries. During the interviews, multiple open-ended questions were used to explore opinions about the OP regulations and how these regulations affected the practice. The interviews were then transcribed and thematically analysed. Results: Responses were mainly received from regulators in SA, Bahrain, Oman and United Arab Emirates (UAE). SA and UAE allow for offering of OP services as add-on service for existing community pharmacy, while UAE also allows for standalone OP providers. SA, Bahrain, and Oman allow online ordering of both over-the-counter (OTC) and prescription-only medications (POM) from international OP; a prescription is required for POM and quantities allowed should be no more than 3 months' supply in case of SA and Oman while this was not specified in case of Bahrain. Invoice of purchase was also required for any POM to be released from customs in SA and Bahrain but not in Oman and UAE. Controlled medications were prohibited to be ordered online in SA, UAE, and Bahrain while it was allowed in Oman if the prescription was issued within 6-month, and the quantity dispensed was for 1 month only. Apart from online ordering of medications in these countries, no specific regulations existed to regulate ordering of other health-related products from local or international OPs. Whether Kwait and Qatar have regulations for OP could not be established due to lack of response. Two of the four interviewed representatives of OP service providers in SA were not aware of the existence of specific regulations for OP services. The representatives who were aware of these regulations were satisfied with them and found them beneficial for their business and for the patients at the same time. However, representatives raised concerns regarding the enforcement of regulations on international OP providers. Conclusion: The existing regulations for online ordering of medications are somewhat comparable between the GCC countries, with no specific regulations for ordering of other health-related products from local or international OPs. In SA, there is limited awareness of the existing regulations for OP services by providers. Nevertheless, the need for detailed regulations on certain aspects of OP services was highlighted, such as regulations for international OPs and importing medications for personal use.
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This research is based on three fundamental aspects of successful biosimilar development in the challenging biopharmaceutical market. First, biosimilar regulations in eight selected countries: Japan, South Korea, the United States, Canada, Brazil, Argentina, Australia, and South Africa, represent the four continents. The regulatory aspects of the countries studied are analyzed, highlighting the challenges facing biosimilars, including their complex approval processes and the need for standardized regulatory guidelines. There is an inconsistency depending on whether the biosimilar is used in a developed or developing country. In the countries observed, biosimilars are considered excellent alternatives to patent-protected biological products for the treatment of chronic diseases. In the second aspect addressed, various analytical AI modeling methods (such as machine learning tools, reinforcement learning, supervised, unsupervised, and deep learning tools) were analyzed to observe patterns that lead to the prevalence of biosimilars used in cancer to model the behaviors of the most prominent active compounds with spectroscopy. Finally, an analysis of the use of active compounds of biosimilars used in cancer and approved by the FDA and EMA was proposed.
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Facial recognition technology (FRT) has emerged as a powerful tool for public governance and security, but its rapid adoption has also raised significant concerns about privacy, civil liberties, and ethical implications. This paper critically examines the current rules and policies governing FRT, highlighting the tensions between state and corporate interests on one hand, and individual rights and ethical considerations on the other. The study also investigates international legal frameworks aimed at protecting individual rights and privacy, arguing that current legislative measures often fall short of robust scholarly standards and international human rights norms. The paper concludes with recommendations for developing principled and adaptable governance frameworks that harness the benefits of FRT while mitigating its risks and negative impacts, underscoring the importance of placing human rights and ethics at the center of regulating this transformative technology.
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This EBCOG guidance reviews the current and future status of genomics within fetal and maternal medicine. This document addresses the clinical uses of genetic testing in both screening and diagnostic testing prenatally. The role of genomics within fetal and maternal medicine is described. The research and future implications of genetic testing as well as the educational, ethical and economic implications of genomics are discussed.
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Testes Genéticos , Genômica , Diagnóstico Pré-Natal , Humanos , Feminino , Gravidez , Diagnóstico Pré-Natal/métodos , Diagnóstico Pré-Natal/tendências , Obstetrícia , Ginecologia , Europa (Continente)RESUMO
Sulphur Emission Control Areas (SECAs), mandated by the International Maritime Organization (IMO), regulate fuel sulphur content (FSC) to mitigate the environmental and health impact of shipping emissions in coastal areas. Currently, FSC is limited to 0.1% (w/w) within and 0.5% (w/w) outside SECAs, with exceptions for ships employing wet sulphur scrubbers. These scrubbers enable vessels using non-compliant fuels such as high-sulphur heavy fuel oils (HFOs) to enter SECAs. However, while sulphur reduction via scrubbers is effective, their efficiency in capturing other potentially harmful gases remains uncertain. Moreover, emerging compliant fuels like highly aromatic fuels or low-sulphur blends lack characterisation and may pose risks. Over three years, we assessed emissions from an experimental marine engine at 25% and 75% load, representative of manoeuvring and cruising, respectively. First, characterizing emissions from five different compliant and non-compliant fuels (marine gas oil MGO, hydro-treated vegetable oil HVO, high-, low- and ultra-low sulphur HFOs), we calculated emission factors (EF). Then, the wet scrubber gas-phase capture efficiency was measured using compliant and non-compliant HFOs. NOx EF varied among fuels (5200-19700 mg/kWh), with limited scrubber reduction. CO (EF 750-13700 mg/kWh) and hydrocarbons (HC; EF 122-1851 mg/kWh) showed also insufficient abatement. Carcinogenic benzene was notably higher at 25% load and about an order of magnitude higher with HFOs compared to MGO and HVO, with no observed scrubber reduction. In contrast, carbonyls such as carcinogenic formaldehyde and acetaldehyde, acting as ozone precursors, were effectively scrubbed due to their polarity and water solubility. The ozone formation potential (OFP) of all fuels was examined. Significant EF differences between fuels and engine loads were observed, with the wet scrubber providing limited or no reduction of gaseous emissions. We suggest enhanced regulations and emission abatements in the marine sector to mitigate gaseous pollutants harmful to human health and the environment.
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The study examines the integration of postbiotics in food products through the use of attenuated probiotics, specifically lactic acid bacteria (LAB) in bread. Postbiotics, non-viable microorganisms or their metabolites, offer health benefits similar to probiotics without the risks associated with live bacteria. This research evaluates the regulatory aspects and safety of LAB in sourdough bread production, highlighting their historical and significant use in Europe before 1997. The study includes microbial quantification and Next-Generation Sequencing (NGS) to identify LAB in traditional sourdough, comparing them with historical and current EFSA Qualified Presumption of Safety (QPS) lists. Findings show that the LAB present in sourdough have been extensively and safely used in bread making, supporting their classification as non-novel foods under EU regulations. The stability and consistency of LAB metabolites in sourdough bread are also confirmed, ensuring quality and safety in each batch. The study concludes that LAB in sourdough, when inactivated through bread-making processes, are not considered novel foods, aligning with historical, scientific, and regulatory evidence.
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Telemedicine, defined as the practice of delivering healthcare services remotely using information and communications technologies, raises a plethora of ethical considerations. As telemedicine evolves, its ethical dimensions play an increasingly pivotal role in balancing the benefits of advanced technologies, ensuring responsible healthcare practices within telemedicine environments, and safeguarding patient rights. Healthcare providers, patients, policymakers, and technology developers involved in telemedicine encounter numerous ethical challenges that need to be addressed. Key ethical topics include prioritizing the protection of patient rights and privacy, which entails ensuring equitable access to remote healthcare services and maintaining the doctor-patient relationship in virtual settings. Additional areas of focus encompass data security concerns and the quality of healthcare delivery, underscoring the importance of upholding ethical standards in the digital realm. A critical examination of these ethical dimensions highlights the necessity of establishing binding ethical guidelines and legal regulations. These measures could assist stakeholders in formulating effective strategies and methodologies to navigate the complex telemedicine landscape, ensuring adherence to the highest ethical standards and promoting patient welfare. A balanced approach to telemedicine ethics should integrate the benefits of telemedicine with proactive measures to address emerging ethical challenges and should be grounded in a well-prepared and respected ethical framework.
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Telemedicina , Telemedicina/ética , Humanos , Direitos do Paciente/ética , Confidencialidade/ética , Segurança Computacional/ética , Relações Médico-Paciente/éticaRESUMO
Addressing resilience, sustainability, and water resource conservation has become increasingly important in the modern world. Challenges arise due to periodic droughts, climate change, and seasonal variability in areas with limited freshwater availability. Therefore, implementing and promoting water reuse is essential. Rainwater harvesting (RWH) is one such alternative, offering benefits in conserving water resources and mitigating droughts while reducing urban flooding and costs by generating alternative lower-cost water sources. Providing users with knowledge of available volumes for harvesting, including homeowners and governmental entities, is key to encouraging this practice. Hydrological data and geographic information systems are fundamental for managing, designing, and projecting rainwater harvesting practices. However, no tools currently integrate this information at multiple scales with current and future climate scenarios. This research aimed to develop a multi-scale assessment tool named H2O HARVEST, for evaluating the availability and potential of rainwater harvesting. Additional benefits of the H2O HARVEST app include aiding decision-making by national governmental entities and analyzing potential future scenarios for homeowner users. The app also provides regulatory policy information at the state level. We offer an app with the necessary capabilities to bridge the technology gap and promote rainwater harvesting practices. Our research demonstrated that RWH has the potential to be a sustainable water reuse practice. For more than 50% of the states, the RWH could supply at least 50% of the water demand. The regions of the US with the greatest potential are the Central and East.