A probability of Guillain-Barre syndrome equal to asthma symptoms 8-10 combimist l inhaler 50/20mcg cheap French Guiana asthma symptoms video order 50/20mcg combimist l inhaler with amex, Martinique asthma treatment medscape order combimist l inhaler pills in toronto, Saint Barthelemy asthma emedicine purchase combimist l inhaler cheap online. In the absence of earnings inforthe market exchange rate obtained from the World Bank’s mation for the year 2015, earnings growth rates obtained World Development Indicators. For was not available for Anguilla, Bonaire, St Eustatius and Saba, countries with missing earnings data. As noted for other estinumber of births per year in each country, obtained from mations, systematic collection of reliable country-specific the World Bank’s World Development Indicators , was cost data is needed. However, number of births to give the total estimated number of Zikathe frequency of microcephaly cases varies substantially infected pregnant women. The direct costs include medical the strength of preventive response in the afiected counexpenses and nonmedical costs. However, lost productivity caused by increased morbidity and premature other neurological, ocular and hearing disorders in babies mortality of people with microcephaly. Bonaire, St Eustatius and Saba, Guadeloupe, Martinique, Another indirect cost of microcephaly (which is not included Saint Barthelemy, Saint Martin, French Guiana. For this report, two scenarios for the participation among parents of children with microcephaly direct costs on international tourism were applied (*). The figures presented in this report Information gathered through desk reviews and consultations need to be considered with caution. Discussions with national stakeholders analysed background factors and delineated institutional responses. Key informants Informal key informant and group interviews were held with frontline health workers, civil society organizations, government representatives, small business owners, communities and individuals afiected by the epidemic. Information on the “population at risk” was not available for the following countries/ territories: Anguilla, Bonaire, St Eustatius and Saba, Curacao, Saint Barthelemy, Saint Martin, Sint Maarten. See Annex 1:Methods and Assumptions, Section 3 for details on assumptions, data sources and calculations. See Annex 1:Methods and Assumptions, Section 5 for details on assumptions, data sources and calculations. For costs A, B and C, given the absence of country-specific costs, following Alfaro Murillo et al. For (D), country-specific market earnings were used as proxy for the value of time devoted by parents to care for children with microcephaly. See Annex 1:Methods and Assumptions, Section 7 for details on assumptions, data sources and calculations. Economic Costs Of Mental Retardation, Cerebral Palsy, Hearing Loss, And Vision Impairment [Internet]. Assessing the socio-economic impacts of Ebola Virus Disease in Guinea, Liberia and Sierra Leone. Decent work and gender equality Policies to improve employment access and quality for women in Latin America and the Caribbean [Internet]. Toward Universal Health Coverage in Latin American and Caribbean: Measuring results of programs to extend financial protection and access to health care for the poor [Internet]. World Water Day: Latin America leads in water management but inequalities in access remain [Internet]. Cumulative Zika suspected and confirmed cases reported by countries and territories in the Americas [Internet]. The short-term economic costs of Zika in Latin America and the Caribbean [Internet]. Cost-efiectiveness of Increasing Access to Contraception during the Zika Virus Outbreak, Puerto Rico, 2016. Risk Factors Associated With the Ophthalmoscopic Findings Identified in Infants With Presumed Zika Virus Congenital Infection. Microcephaly in north-east Brazil: a retrospective study on neonates born between 2012 and 2015. In: Beijing declaration and platform for action: adopted by the Fourth World Conference on Women: action for equality, development and peace, Beijing, China, 4–15 September 1995 [Internet]. Moving toward universal access to health and universal health coverage: a review of comprehensive primary health care in Suriname. Abortion possible in Tai birth defect cases linked to Zika, oficials say [Internet]. Evidence on impact of community-based environmental management on dengue transmission in Santiago de Cuba. Efiect of a participatory intervention with women’s groups on birth outcomes in Nepal: cluster-randomised controlled trial [Internet]. Zika Virus Infects Neural Progenitors in the Adult Mouse Brain and Alters Proliferation. Guillain-Barre Syndrome outbreak associated with Zika virus infection in French Polynesia: a case-control study. Such forward-looking statements involve known and unknown risks, uncertainties, and other important factors, which could cause actual results, performance or achievements to differ materially from those expressed or implied in such statements. These risks and uncertainties include, but are not limited to, the unpredictable nature of our early stage development efforts for our novel product candidates; failure to raise additional capital as required; unexpected regulatory decisions regarding any of these activities, unexpected expenses or inaccurate financial assumptions or forecasts; additional or increased litigation efforts by our competitors; insufficient resources or failure to prioritize competing projects and efforts; disputes with our collaboration partners; inability to successfully partner the development and commercialization of our product candidates; delays or unfavorable decisions of regulatory agencies; unfavorable regulatory guidance pronouncements; safety, efficacy or tolerability problems with our product candidates; and competition for targeted indications or within targeted markets. Information provided in this presentation speaks only as of the date of this presentation, and we assume no obligation to update forward-looking statements to reflect events or circumstances occurring after this presentation. The Company does not expect restructuring expense and collaborative reimbursement revenue to be material. Two other engaging collaborative work, and the rigorous critical review committee members, along with an external expert for select of fact sheets contained herein, we believe that this document fact sheets, provided secondarypeer-reviewofeachfactsheet. In this a minimum of 10 cases published in the last decade in peeredition, we have continued to use the table format at the start reviewed journals, ideally by more than one group. Leukocytapheresis A procedure in which blood of the patient is passed through a medical device which separates out white blood cells. Rheopheresis A therapeutic procedure in which blood of the patient is passed through a medical device which separates out high-molecular weight plasma components such as fibrinogen, fi2-macroglobulin, low-density lipoprotein cholesterol, and IgM in order to reduce plasma viscosity and red cell aggregation. In the Fifth, Sixth and Seventh Edithe process of developing new and amending old fact tions, the Grading of Recommendations Assessment, Develsheets consisted of four steps (Figure 2). The memdraft (draft I) of the fact sheet to two other members of the bers of the committee carefully took these variables into committee for critique and comment. As an example, the “Transplantation, lung” eases or conditions are summarized in Table 1. The name of the disease as well as its eponym or common abbreviation when appropriate. In some instances, when the incidence varies between genders, ethnicity, age, or race, this information is noted as well. The reader is cautioned to use this information only as a general indicator of disease incidence or prevalence. This section is used when there are several different therapeutic apheresis procedures used and it was necessary to subdivide available scientific reports, as well as in the situation when different subsets of patients are being analyzed. The patient count includes all patients irrespective of randomization to either treatment group (with therapeutic apheresis) or the control arm. Patient counts should be not regarded as exact figures of all existing literature, but reflecting the magnitude of published evidence for a particular indication, and representing the major source of evidence used to assign category and grade recommendation. This section briefly describes technical suggestions relevant to the treated disease, which the committee believed were important to improve quality of care or increase chances of a positive clinical outcome. Not all diseases may have specific technical notes; in such instances, a general statement referring to the introductory text is provided. Application of this information may vary depending on the patient and clinical presentation, and is left to the discretion to the treating physician. The committee believes that a thoughtful approach to patient management is required to establish reasonable and scientifically sound criteria for discontinuation of treatment. Impact the effect of therapeutic apheresis on co-morbidities and medications (and vice-versa) should be considered. Technical issues* the technical aspects of therapeutic apheresis such as a type of anticoagulant, replacement solution, vascular access, and volume of whole blood processed. Therapeutic plan* Total number and/or frequency of therapeutic apheresis procedures should be addressed. The location where the therapeutic apheresis will take place should be also addressed. If the timing appropriate to the clinical condition and urgency level cannot be met, a transfer to a different facility should be considered based on the clinical status of the patient.
Sytemic lymph node dissection and anatomic pulmonary resection should be performed asthma definition zephyr discount combimist l inhaler on line, especially in those who have the larger size of solid part and suspicion of visceral pleural invasion asthma vcd treatment order 50/20 mcg combimist l inhaler with amex. Ikeda Tokyo Medical University asthma symptoms 3 weeks combimist l inhaler 50/20mcg line, Tokyo/Japan Background: Pathological diferentiation is an established prognostic factor for patients with lung adenocarcinoma asthma symptoms for adults buy combimist l inhaler us. The median post-surgical There were 4 complications (empyema, pneumothorax, chylothorax hospital stay was eight days (4 – 28 days). However, short-term or long-term treatment outcomes treating these patients but with conficting conclusions. Twenty-three patients had rheumatoid arthritis, and Result: We included a total of 354 patients for fnal analysis. The primary endpoint is progressioncases of anatomic lung resection, the specifc procedures and free survival; secondary endpoints include overall survival, safety, corresponding number of cases were as follows: segmentectomy, 90; lung function assessment, objective response, duration of response, lobectomy, 218; sleeve lobectomy, 9; ipsilateral lobe combined with pharmacokinetics, and immunogenicity. This phase 2 trial was segment resected synchronously (i-L+S), 6; and pneumonectomy, activated on April 2, 2019 and frst patient in is anticipated for May 22, 3. Result: Section not applicable cases were converted to multiportal thoracoscopic surgery. All Conclusion: Section not applicable patients underwent systematic mediastinal lymphadenectomy. Conclusion: Complete uniportal anatomic lung resection, particularly for segmentectomy and lobectomy is safe L. Van Schil and feasible with low complication rates, and excellent free resection Antwerp University Hospital, Edegem/Belgium margin rates. Systematic mediastinal lymphadenectomy during complete uniportal thoracoscopic surgery adequately assesses the Background: In spite of the progress made in recent years N2 lymph node. We investigated early and long-term results in a recent lung resection series of patients undergoing pneumonectomy for lung cancer. Result: A total of 61 patients, 48 men and 13 women with an overall mean age of 64±8. Result: the mean age this trend was also observed across diferent treatment categories, at the surgery was 63 years (range 39~86), with 5 women and 28 where female survival signifcantly exceeded that of males: curativemen. Six years after the #Palliative salvage surgery, there was no recurrence of lung cancer. We excluded patients with unclear basic information (such as sex, histology or cause of death), multiple primary malignant tumor and M1 disease. The baseline characteristics of majority were as follows: New York Presbyterian Hospital-Weill Cornell Medical College, New York/ agefi65 (55. In propensity-matched groups, there were no diferences in 30-day readmission (3% vs. Conclusion: National use of minimally-invasive surgery following induction therapy increased signifcantly over the study period. Ozkok Ege University Medical School & Hospital, Izmir/Turkey Background: Brain metastasis is a poor prognostic factor for survival in all cancer types. Ikeda Mitsui Memorial Hospital, Tokyo/Japan Background: the removal of the whole regional lymphatic system together with primary tumor is one of the important rules in oncological surgery. Due to anatomical limitations imposed by arch of aorta, it is difcult to perform complete dissection of upper zone mediastinal lymph nodes through the left thoracotomy in the left lung cancer. Tape the right and left recurrent laryngeal nerve and dissect the highest paratracheal lymph nodes in the thoracic inlet. And dissect the pre and paratracheal nodes, together with bilateral highest nodes. Tie of the blood vessels (arteries and veins) and airways leading to the afected lobe, and then remove the lobe. Result: Overall 5-year survival rate in the 218 patients of left upper lung primary was 65. When faced with a patient with resectable mediastinal lymph node metastasis, we should consider Extended bilateral mediastinal lymph node dissection through a median sternotomy. To improve survival rate, it is important to perform curative operation with upper zone mediastinal dissection. Keywords: Upper Zone lymph node dissection, Non-small-cell carcinoma of the left upper lung. Miele, values for lymph nodes were additional prognostic factors besides 1 2 R. Even if literature data document a signifcant advantage also for elderly population, these selected group of patients is usually underrepresented in randomized trials. This study analyzed treatment and outcomes at our institution according to elderly (>70 years old) or younger (fi70 years) age. A signifcant diference in overall survival was appreciated according to treatment period also for elderly population. No signifcant diferences were reported in esophageal and lung toxicities between elderly A. Cheng5 G3: 1,7% and 2,6%; Lung G2: 6,4% and 6,3%; Lung fiG3: 5,7% and 1Department of Medical Oncology / Montefore Medical Center, Bronx/ 3,1%, respectively). The improved outcome 5 Montefore Medical Center, Bronx/United States of America, Montefore obtained in younger patients in the modern era is achievable also for Medical Center/Albert Einstein College of Medicine, Bronx/United States of this selected elderly population. Moro-1 1 1 1 1 1 1 barriers in this diverse patient population and gain insights into realSibilot, M. It is therefore necessary to evaluate our current practices comparisons between subgroups were made using log-rank testing, in order to identify the patients that should most likely receive this adjusted by Cox proportional hazards regression. The majority of the patients (n=270, criteria due to co-morbidities and/or additional malignancy. Sixty-nine (17%) patients received exclusive days before 7/2018 to 30 days afterwards (p=0. Several eligible chemoradiotherapy, and 60 (15%) were planned for neoadjuvant patients did not receive durvalumab due to questionable beneft in chemotherapy for subsequent surgery. Compared to patients who received durvalumab, patients who received surgery in accordance with the multidisciplinary meeting did not receive it were found to be of a lower socioeconomic status decision; 6 (10%) received concurrent chemoradiotherapy and 6 (p=0. Moreover, there was a trend toward improved 15-month (10%) sequential chemoradiotherapy. It can be both applied as radical intent in local disease or as palliation in metastatic or non-curative setting. Method: Retrospective analysis of consecutive initial survival data in a real world setting. Result: 16 patients were analysed, 15 (94%) males, age 69 (+/-8) years-old, 3 (19%) were P2. Background: Pretreatment nutritional status critically afects the clinical outcomes. Mean disease the surrounding structures easily promotes the invasion-related free-survival was 24. Method: We enrolled 127 patients who received trimodality therapy at our institution between 1999 and 2016. Result: Fifty-fve and 72 patients were diagnosed as clinical T1/2 (cT1/2) and cT3/4 diseases, respectively, and, 42 and 85 patients were cN0/1 and cN2/3, respectively. Longer survival has been described in patients who a signifcant cutof was identifed only in cT3/4 patients. In all cases the bronchial stumps Yedikule Chest Disease and Thoracic Surgery Hospital, Istanbul/Turkey were covered with autologous tissue including pedunculated intercostal muscle or mediastinal fat pad. There were no deaths within Background: Despite early stage operated lung cancer’s better 30 days. Method: Data was collected retrospecively between the recucurence free suvavals were 56. The years of january 2009 through December 2017 at Yedikule Hospital average observation period of alive patients was 2500 days (range, for Chest Disease Hospital. Patients with exploratory thoracotomy, neoadjuvan treatment and who lost follow-up were excluded from the study. When overall survival were compared by stage there was statistically signifcant diference. When overall survival were compared by histopathologic type, combined neuroendocrine carcinomas refect the least overall survival value but the diference is not statistically signifcant. There is no statistically signifcant diference betwen However, due to a high complication rate, surgery by experienced small cell and large cell neuroendocrine tumours’ overall survival surgeons and careful postoperative management are essential for values (p=0. Yamamoto1 1 1 1 1 the feasibility of the technique and its results in patients undergoing 1 2 lung and chest wall resection by means of minimally invasive surgery. Fourteen patients, all but three males with a median has also been reported of having an acceptable safety and favorable age of 62 ± 6.
Questions about sexual contacts can be included in the questionnaire if warranted by a risk assessment conducted within the framework of the national preparedness plan the risk of infectious donation by donor having sexual contact with person returning from an area with active transmission is assessed to asthma definition zen buy combimist l inhaler on line be extremely low asthma treatment and nursing care part 1 purchase combimist l inhaler 50/20 mcg fast delivery. Under specific conditions asthma yellow zone buy discount combimist l inhaler 50/20 mcg online, reproductive tissue establishments can continue with fertility preservation asthma definition qi buy combimist l inhaler discount, for example when postponing an assisted reproductive technology procedure would significantly worsen a couple’s chances to conceive. There is accumulating evidence that Zika virus is present in sperm for a longer period than in whole blood, saliva or urine. Serological testing such as enzyme immunoassays and immunofluorescence assays for the presence of anti-Zika IgM antibodies in the blood sample may be used to exclude false negatives. Tissue establishment should temporary interrupt sperm donation during active transmission in an area and reinstate donation six months after the last case has been reported. Donation of other reproductive tissues and cells: oocytes and embryos (in vitro fertilisation), and ovarian and testicular tissues (fertility preservation) Areas with active transmission. Tissue establishments in areas with active transmission should temporarily interrupt in vitro fertilisation and fertility preservation, except under specific conditions. Fertility preservation or in vitro fertilisation may also be performed when suspending would significantly worsen a couple’s chances to conceive. Tissue establishments may reinstate procedures for fertility preservation and in vitro fertilisation, two to six months after the last case has been reported in an area. Female donations (fertility preservation and assisted reproductive technology procedure): deferral for at least 28 days after diagnosed illness, return from areas with active transmission, or sexual contact with a male diagnosed with Zika virus infection. Non-reproductive tissues and cells Cord blood and placental tissues Pregnant women with a diagnosis of Zika virus infection are not eligible to donate cord blood or placental tissues. This may prevent the donation of infected cord blood by women who were exposed to Zika virus in early pregnancy at the end of the outbreak. Areas with active transmission Due to the high proportion of asymptomatic cases of Zika virus infection, deferral policies might be ineffective in the active transmission risk areas. The presence of risk factors for Zika virus infection should be identified by reviewing the medical, behavioural and travel history as well as the post-mortem examination of a donor. Deceased donors who were diagnosed with Zika virus disease in the last 28 days, or returned from areas with active transmission, should not be used as tissue or cell donors. Using only a donor’s medical and behavioural history in the selection of deceased donors may be insufficient in areas with active transmission because of the high proportion of asymptomatic infections. Based on the level of risk determined by a risk assessment on the safety of tissues, tissue establishments can temporarily suspend or resume tissue donations in areas with active transmission under specific conditions. If tissue donation was temporarily suspended in areas with active transmission, needed tissue products should be supplied from parts of the country that report no active transmission. If tissue donation in area with active transmission continues, all tissue donors/donations have to be laboratory screened, and, if possible, tissue products should be inactivated using appropriate pathogen inactivation technology. The virus may have infected deceased organ donors prior or during their terminal illness. It is, however, unknown whether organs infected with Zika virus transmit the disease. It appears that Zika virus transmission through organ transplantation is possible, but no cases have been reported to date. Thus, the organ transplant community should be aware of the threat posed by Zika virus to solid organ transplant donors and recipients. A possible Zika virus infection in an organ donor should not automatically lead to exclusion from the donation, except when the organ recipient is a pregnant woman . The risk of infection through living or deceased donation should be assessed during a pre-donation evaluation and balanced against the risk of losing the opportunity of solid organ transplantation. Transplant clinicians have a key role in the risk–benefit analysis (this includes life-threatening emergencies) and in the decision whether to perform a transplant, even when part of the data on organ and donor characterisation might still be incomplete at the moment of the transplant decision; this might be the case if tests results on infectious diseases are not yet available, as organs cannot be preserved for a long time . Information on the severity of Zika virus infection in immunosuppressed patients is limited to a small number of cases. No conclusions can be drawn about the effect of immunosuppression on the clinical course of Zika virus infection in solid organ transplant patients and the impact of Zika virus on allograft function . Organ availability is the primary limiting factor affecting the number of transplant procedures that can be performed. An accurate and timely assessment of the infection risk, both for the solid organ transplant donor and the recipient, based on epidemiologic exposure and medical examination, could lower the risk of disease transmission. The risk of Zika virus infection should be balanced against the benefits of transplantation. If indicated, donations from living donors at risk of Zika virus infection can be postponed for 28 days after possible exposure or cessation of Zika virus disease symptoms. Viraemic donors should not be used without prior consultation with a transplant infectious disease expert. Post-mortem donation Routine laboratory screening of deceased organ donors at risk for the presence of Zika virus infection is not recommended because there is not enough time for an exhaustive investigation, except for tests for which results are likely to be available within a few hours. The results of the test should be communicated to the transplanting clinician so that a follow-up can be arranged if the test results were positive. If a donor (living or deceased) is diagnosed with Zika virus infection after the transplantation of the donated material, the tissue establishment/procurement centre should report the incident to the relevant authority as a serious adverse event and provide information on the outcome. At the same time, the tissue establishment/procurement centre should inform the transplant centres that performed the transplantations about the incident. If tissues, cells or organs were supplied cross-border, information should be provided to all involved parties, i. Findings of possible, probable or confirmed donor-derived infections should be reported to the relevant authority as serious adverse reactions and the national biovigilance system. If the donor-derived infection can be excluded, Zika virus infection of other origins in an organ recipient should also be reported to the relevant authority. The transplant centre should also initiate a clinical and laboratory follow-up for recipients of tissue, cells, or organs with a confirmed Zika virus infection. The presence of the virus in blood and urine should be checked weekly until negative results are obtained. West Nile virus and blood safety introduction to a preparedness plan in Europe Brussels: European Commission; 2012 [cited 2016]. Zika virus and safety of substances of human origin A guide for preparedness activities in Europe. Potential for Zika virus transmission through blood transfusion demonstrated during an outbreak in French Polynesia, November 2013 to February 2014. Two cases of Zika fever imported from French Polynesia to Japan, December 2013 to January 2014. Simultaneous outbreaks of dengue, chikungunya and Zika virus infections: diagnosis challenge in a returning traveller with nonspecific febrile illness. Zika virus infection complicated by Guillain-Barre syndrome case report, French Polynesia, December 2013. Guillain-Barre syndrome outbreak associated with Zika virus infection in French Polynesia: a case-control study. Zika situation report: Neurological syndrome and congenital anomalies, 5 February 2016 [Internet]. Vertical transmission of Zika virus targeting the radial glial cells affects cortex development of offspring mice. Rapid risk assesment Zika virus disease epidemic: potential association with microcephaly and Guillain-Barre syndrome. Rapid risk assessment Zika virus disease epidemic: potential association with microcephaly and Guillain-Barre syndrome. Rapid risk assessment Zika virus epidemic in the Americas: potential association with microcephaly and Guillain-Barre syndrome. National Institutes of Health, National Institute of Allergy and Infectious Diseases. Zika situation report: Zika virus, microcephaly, Guillain-Barre syndrome, 27 October 2016 [Internet]. Zika situation report: Zika virus, microcephaly, Guillain-Barre syndrome, 10 March 2017 [Internet]. Communicable disease threats report, 11-17 December 2016, week 50 2016 [cited 2016]. Rapid risk Assessment Zika virus disease epidemic, Tenth update, 4 April 2017 2017. First record of Aedes (Stegomyia) aegypti (Linnaeus, 1762) (Diptera, Culicidae) in Madeira Island Portugal. Introduction and control of three invasive mosquito species in the Netherlands, July-October 2010. Aedes (Stegomyia) albopictus (Skuse): a potential vector of Zika virus in Singapore.
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Promote new biotechnologies for tapping mineral resources in an environmentally sustainable manner asthma definition and pathophysiology purchase combimist l inhaler 50/20 mcg on line. Steps should be taken to asthma definition zenith cheap combimist l inhaler online increase access both to asthmatic bronchitis recovery cheap combimist l inhaler 50/20 mcg on-line existing information about biotechnology and to asthma symptoms lungs generic combimist l inhaler 50/20 mcg line facilities based on global databases. Governments at the appropriate level, with the support of relevant international and regional organizations, should: a. Strengthen research, training and development capabilities, particularly in developing countries, to support the activities outlined in this programme area; b. Develop mechanisms for scaling up and disseminating environmentally sound biotechnologies of high environmental importance, especially in the short term, even though those biotechnologies may have limited commercial potential; c. Enhance cooperation, including transfer of biotechnology, between participating countries for capacity-building; d. Develop appropriate safety procedures based on programme area D, taking account of ethical considerations. The Conference secretariat has estimated the average total annual cost (1993-2000) of implementing the activities of this programme to be about $1 billion, including about $10 million from the international community on grant or concessional terms. The activities for this programme area will increase the demand for trained personnel. Support for existing training programmes needs to be increased, for example, at the university and technical institute level, as well as the exchange of trained personnel between countries and regions. New and additional training programmes also need to be developed, for example, for technical and support personnel. There is also an urgent need to improve the level of understanding of biological principles and their policy implications among decision makers in Governments, and financial and other institutions. Relevant institutions will need to have the responsibility for undertaking, and the capacity (political, financial and workforce) to undertake, the above-mentioned activities and to be dynamic in response to new biotechnological developments (see programme area E). Enhancing safety and developing international mechanisms for cooperation Basis for action 16. There is a need for further development of internationally agreed principles on risk assessment and management of all aspects of biotechnology, which should build upon those developed at the national level. Only when adequate and transparent safety and border-control procedures are in place will the community at large be able to derive maximum benefit from, and be in a much better position to accept the potential benefits and risks of, biotechnology. Several fundamental principles could underlie many of these safety procedures, including primary consideration of the organism, building on the principle of familiarity, applied in a flexible framework, taking into account national requirements and recognizing that the logical progression is to start with a step -by-step and case-bycase approach, but also recognizing that experience has shown that in many instances a more comprehensive approach should be used, based on the experiences of the first period, leading, inter alia, to streamlining and categorizing; complementary consideration of risk assessment and risk management; and classification into contained use or release to the environment. The aim of this programme area is to ensure safety in biotechnology development, application, exchange and transfer through international agreement on principles to be applied on risk assessment and management, with particular reference to health and environmental considerations, including the widest possible public participation and taking account of ethical considerations. The proposed activities for this programme area call for close international cooperation. They should build upon planned or existing activities to accelerate the environmentally sound application of biotechnology, especially in developing countries. Make the existing safety procedures widely available by collecting the existing information and adapting it to the specific needs of different countries and regions; b. Further develop, as necessary, the existing safety procedures to promote scientific development and categorization in the areas of risk assessment and risk management (information requirements; databases; procedures for assessing risks and conditions of release; establishment of safety conditions; monitoring and inspections, taking account of ongoing national, regional and international initiatives and avoiding duplication wherever possible); c. Compile, update and develop compatible safety procedures into a framework of internationally agreed principles as a basis for guidelines to be applied on safety in biotechnology, including consideration of the need for and feasibility of an international agreement, and promote information exchange as a basis for further development, drawing on the work already undertaken by international or other expert bodies; d. Undertake training programmes at the national and regional levels on the application of the proposed technical guidelines;. Assist in exchanging information about the procedures required for safe handling and risk management and about the conditions of release of the products of biotechnology, and cooperate in providing immediate assistance in cases of emergencies that may arise in conjunction with the use of biotechnology products. Governments at the appropriate level, with the support of the relevant international and regional organizations, should raise awareness of the relative benefits and risks of biotechnology. Organizing one or more regional meetings between countries to identify further practical steps to facilitate international cooperation in bio-safety; b. Establishing an international network incorporating national, regional and global contact points; c. Providing direct assistance upon request through the international network, using information networks, databases and information procedures; d. Considering the need for and feasibility of internationally agreed guidelines on safety in biotechnology releases, including risk assessment and risk management, and considering studying the feasibility of guidelines which could facilitate national legislation on liability and compensation. Adequate international technical and financial assistance should be provided and technical cooperation to developing countries facilitated in order to build up technical, managerial, planning and administrative capacities at the national level to support the activities in this programme area (see also programme area E). Establishing enabling mechanisms for the development and the environmentally sound application of biotechnology Basis for action 16. The accelerated development and application of biotechnologies, particularly in developing countries, will require a major effort to build up institutional capacities at the national and regional levels. In developing countries, enabling factors such as training capacity, know-how, research and development facilities and funds, industrial building capacity, capital (including venture capital) protection of intellectual property rights, and expertise in areas including marketing research, technology assessment, socio-economic assessment and safety assessment are frequently inadequate. Efforts will therefore need to be made to build up capacities in these and other areas and to match such efforts with appropriate levels of financial support. There is therefore a need to strengthen the endogenous capacities of developing countries by means of new international initiatives to support research in order to speed up the development and application of both new and conventional biotechnologies to serve the needs of sustainable development at the local, national and regional levels. National mechanisms to allow for informed comment by the public with regard to biotechnology research and application should be part of the process. Some activities at the national, regional and global levels already address the issues outlined in programme areas A, B, C and D, as well as the provisioin of advice to individual countries on the development of national guidelines and systems for the implementation of those guidelines. These activities are generally uncoordinated, however, involving many different organizations, priorities, constituencies, time-scales, funding sources and resource constraints. There is a need for a much more cohesive and coordinated approach to harness available resources in the most effective manner. As with most new technologies, research in biotechnology and the application of its findings could have significant positive and negative socio-economic as well as cultural impacts. These impacts should be carefully identified in the earliest phases of the development of biotechnology in order to enable appropriate management of the consequences of transferring biotechnology. To promote the development and application of biotechnologies, with special emphasis on developing countries, by: i. Providing the necessary support for biotechnology, particularly research and product development, at the national, regional and international levels; iii. Raising public awareness regarding the relative beneficial aspects of and risks related to biotechnology, to contribute to sustainable development; iv. Helping to create a favourable climate for investments, industrial capacitybuilding and distribution/marketing; v. Encouraging the exchange of scientists among all countries and discouraging the "brain drain"; vi. Recognizing and fostering the traditional methods and knowledge of indigenous peoples and their communities and ensuring the opportunity for their participation in the economic and commercial benefits arising from developments in biotechnology; 9/ b. To identify ways and means of enhancing current efforts, building wherever possible on existing enabling mechanisms, particularly regional, to determine the precise nature of the needs for additional initiatives, particularly in respect of developing countries, and to develop appropriate response strategies, including proposals for any new international mechanisms; c. To establish or adapt appropriate mechanisms for safety appraisal and risk assessment at the local, regional and international levels, as appropriate. Governments at the appropriate level, with the support of international and regional organizations, the private sector, non-governmental organizations and academic and scientific institutions, should: a. Develop policies and mobilize additional resources to facilitate greater access to the new biotechnologies, particularly by and among developing countries; b. Implement programmes to create greater awareness of the potential and relative benefits and risks of the environmentally sound application of biotechnology among the public and key decision makers; c. Undertake an urgent review of existing enabling mechanisms, programmes and activities at the national, regional and global levels to identify strengths, weaknesses and gaps, and to assess the priority needs of developing countries; d. Undertake an urgent follow-up and critical review to identify ways and means of strengthening endogenous capacities within and among developing countries for the environmentally sound application of biot echnology, including, as a first step, ways to improve existing mechanisms, particularly at the regional level, and, as a subsequent step, the consideration of possible new international mechanisms, such as regional biotechnology centres;. Develop strategic plans for overcoming targeted constraints by means of appropriate research, product development and marketing; f. Establish additional quality-assurance standards for biotechnology applications and products, where necessary. The following activities should be undertaken: facilitation of access to existing information dissemination systems, especially among developing countries; improvement of such access where appropriate; and consideration of the development of a directory of information. Governments at the appropriate level, with the assistance of international and regional organizations, should develop appropriate new initiatives to identify priority areas for research based on specific problems and facilitate access to new biotechnologies, particularly by and among developing countries, among relevant undertakings within those countries, in order to strengthen endogenous capacities and to support the building of research and institutional capacity in those countries. Actual costs and financial terms, including any that are nonconcessional, will depend upon, inter alia, the specific strategies and programmes Governments decide upon for implementation. Workshops, symposia, seminars and other exchanges among the scientific community at the regional and global levels, on specific priority themes, will need to be organized, making full use of the existing scientific and technological manpower in each country for bringing about such exchanges.
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