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The International Health Regulations (IHR), which is legally binding in 196 countries, provides the foundation for global health security (GHS). Although the IHR aligns with human rights principles, it presents no explicit ethical framework. A more explicit engagement with ethics in the IHR, and GHS more generally, is urgently needed to improve global readiness for and responses to future pandemics. Addressing existing inequities and power imbalances in GHS requires a framework for balancing existing ethics frameworks for public health, research, and healthcare delivery. Public health measures should be framed and evaluated in terms of human dignity and values, taking marginalized persons into account. Recommendations are presented on how ethics and human rights can be better integrated into the IHR to support GHS. Existing models for balancing ethics during public health emergencies may be a useful model for developing a framework for ethics and GHS. © 2023 Elsevier Inc. All rights reserved.

The International Health Regulations (IHR), which is legally binding in 196 countries, provides the foundation for global health security (GHS). Although the IHR aligns with human rights principles, it presents no explicit ethical framework. A more explicit engagement with ethics in the IHR, and GHS more generally, is urgently needed to improve global readiness for and responses to future pandemics. Addressing existing inequities and power imbalances in GHS requires a framework for balancing existing ethics frameworks for public health, research, and healthcare delivery. Public health measures should be framed and evaluated in terms of human dignity and values, taking marginalized persons into account. Recommendations are presented on how ethics and human rights can be better integrated into the IHR to support GHS. Existing models for balancing ethics during public health emergencies may be a useful model for developing a framework for ethics and GHS. © 2023 Elsevier Inc. All rights reserved.

Background: Cardiac rehabilitation (CR) is a clinically-effective but complex model of care. The purpose of this study was to characterize the nature of CR programs around the world, in relation to guideline recommendations, and compare this by World Health Organization (WHO) region. Methods: In this cross-sectional study, a piloted survey was administered online to CR programs globally. Cardiac associations and local champions facilitated program identification. Quality (benchmark of ≥ 75% of programs in a given country meeting each of 20 indicators) was ranked. Results were compared by WHO region using generalized linear mixed models. Findings: 111/203 (54.7%) countries in the world offer CR; data were collected in 93 (83.8%; N = 1082 surveys, 32.1% program response rate). The most commonly-accepted indications were: myocardial infarction (n = 832, 97.4%), percutaneous coronary intervention (n = 820, 96.1%; 0.10), and coronary artery bypass surgery (n = 817, 95.8%). Most programs were led by physicians (n = 680; 69.1%). The most common CR providers (mean = 5.9 ± 2.8/program) were: nurses (n = 816, 88.1%; low in Africa, p < 0.001), dietitians (n = 739, 80.2%), and physiotherapists (n = 733, 79.3%). The most commonly-offered core components (mean = 8.7 ± 1.9 program) were: initial assessment (n = 939, 98.8%; most commonly for hypertension, tobacco, and physical inactivity), risk factor management (n = 928, 98.2%), patient education (n = 895, 96.9%), and exercise (n = 898, 94.3%; lower in Western Pacific, p < 0.01). All regions met ≥ 16/20 quality indicators, but quality was < 75% for tobacco cessation and return-to-work counseling (lower in Americas, p ≤ 0.05). Interpretation: This first-ever survey of CR around the globe suggests CR quality is high. However, there is significant regional variation, which could impact patient outcomes.

Background: Despite the epidemic of cardiovascular disease and the benefits of cardiac rehabilitation (CR), availability is known to be insufficient, although this is not quantified. This study ascertained CR availability, volumes and its drivers, and density. Methods: A survey was administered to CR programs globally. Cardiac associations and local champions facilitated program identification. Factors associated with volumes were assessed using generalized linear mixed models, and compared by World Health Organization region. Density (i.e. annual ischemic heart disease [IHD] incidence estimate from Global Burden of Disease study divided by national CR capacity) was computed. Findings: CR was available in 111/203 (54.7%) countries; data were collected in 93 (83.8% country response; N = 1082 surveys, 32.1% program response rate). Availability by region ranged from 80.7% of countries in Europe, to 17.0% in Africa (p < 0.001). There were 5753 programs globally that could serve 1,655,083 patients/year, despite an estimated 20,279,651 incident IHD cases globally/year. Volume was significantly greater where patients were systematically referred (odds ratio [OR] = 1.36, 95% confidence interval [CI] = 1.35–1.38) and programs offered alternative models (OR = 1.05, 95%CI = 1.04–1.06), and significantly lower with private (OR = 0.92, 95%CI = 0.91–0.93) or public (OR = 0.83, 95%CI = 0.82–0.84) funding compared to hybrid sources. Median capacity (i.e., number of patients a program could serve annually) was 246/program (Q25–Q75 = 150–390). The absolute density was one CR spot per 11 IHD cases in countries with CR, and 12 globally. Interpretation: CR is available in only half of countries globally. Where offered, capacity is grossly insufficient, such that most patients will not derive the benefits associated with participation.

Introduction. Geese are one of the most ancient poultry species, domesticated about 3000–2500 B.C. There are currently several different goose production techniques, some of them known from time immemorial: 1) force-feeding for fat liver (Egypt, 2686–2181 B.C.); 2) selection for extremely large body size, exceeding that of modern Toulouse geese (Egypt, 600 B.C. – 200 A.D.); and 3) feather plucking, introduced by ancient Egyptians and Romans. Commercial goose breeding today is dispersed as almost cosmopolitan. The majority of world goose flocks are concentrated in Asia, predominantly in China. In Europe, especially eastern Europe, we observe plentiful goose breed diversity (Fig. 1). The main goose products are raw and processed foodstuffs (meat, fat liver, and goose fat) and down and feathers for stuffing... Conclusion. Further progress in goose production will depend on new tendencies in world market development and diversification, and will rely on advances in selection and management utilizing goose biological and economic features. Integration of genetic, nutritional, reproductive and management approaches — all of which are necessary for more complete utilization of goose genetic potential and adjustment to specific production systems — will aid sustainable production of a variety of healthy and high-quality goose products.

High harmonic generation (HHG) of intense infrared laser radiation (Ferray et al., J. Phys. B: At. Mol. Opt. Phys. 21:L31, 1988; McPherson et al., J. Opt. Soc. Am. B 4:595, 1987) enables coherent vacuum-UV (VUV) to soft-X-ray sources. In the usual setup, energetic femtosecond laser pulses are strongly focused into a gas jet, restricting the interaction length to the Rayleigh range of the focus. The average photon flux is limited by the low conversion efficiency and the low average power of the complex laser amplifier systems (Keller, Nature 424:831, 2003; Südmeyer et al., Nat. Photonics 2:599, 2008; Röser et al., Opt. Lett. 30:2754, 2005; Eidam et al., IEEE J. Sel. Top. Quantum Electron. 15:187, 2009) which typically operate at kilohertz repetition rates. This represents a severe limitation for many experiments using the harmonic radiation in fields such as metrology or high-resolution imaging. Driving HHG with novel high-power diode-pumped multi-megahertz laser systems has the potential to significantly increase the average photon flux. However, the higher average power comes at the expense of lower pulse energies because the repetition rate is increased by more than a thousand times, and efficient HHG is not possible in the usual geometry. So far, two promising techniques for HHG at lower pulse energies were developed: external build-up cavities (Gohle et al., Nature 436:234, 2005; Jones et al., Phys. Rev. Lett. 94:193, 2005) and resonant field enhancement in nanostructured targets (Kim et al., Nature 453:757, 2008). Here we present a third technique, which has advantages in terms of ease of HHG light extraction, transverse beam quality, and the possibility to substantially increase conversion efficiency by phase-matching (Paul et al., Nature 421:51, 2003; Ren et al., Opt. Express 16:17052, 2008; Serebryannikov et al., Phys. Rev. E (Stat. Nonlinear Soft Matter Phys.) 70:66611, 2004; Serebryannikov et al., Opt. Lett. 33:977, 2008; Zhang et al., Nat. Phys. 3:270, 20

We present the first passively modelocked thin disk laser (TDL) with sub-100-fs pulse duration using the broadband sesquioxide gain material Yb:LuScO3 and an optimized SEmiconductor Saturable Absorber Mirror (SESAM). In this proof-of-principle experiment, we obtained 5.1W of average power at a repetition rate of 77.5MHz and a pulse duration of 96fs. We carefully explored and optimized the different parameters on the soliton pulse formation process for the generation of short pulses. In particular, SESAMs combining fast recovery time, high modulation depth and low nonsaturable losses proved crucial to achieve this result even though they are expected to only play a minor role in soliton modelocking. To our knowledge, these are the shortest pulses ever obtained with a modelocked TDL, reaching for the first time the sub-100-fs milestone. This result opens the door to sub-100-fs oscillators with substantially higher power levels in the near future