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The article addresses the issues in healthcare delivery and organization of public healthcare in the face of rapid advancements in digital technologies. The purpose of the study is to outline the legal challenges arising during the implementation of concepts such as digital health, e-health, mobile health as well as establishing the legal framework for electronic medical records and telemedicine, and certain types of innovative biomedical activities. The article illustrates the consistent impact of information and communication technologies on the interaction between patients and healthcare providers. It defines the legal framework for telemedicine and its transition to e-health. The study systematizes the particularities of legal regulations concerning both general electronic medical record and those developed by specialized medical organizations. It presents legal challenges related to data compatibility and potential cross-border exchanges. The concept of mobile healthcare is analyzed, with attention given to the risks associated with its development, notably threats to privacy and cybersecurity. The main directions of digital medicine and the challenges faced by modern legal regulations are summarized, including the use of big data, the integration of artificial intelligence, translational bioinformatics, gamification of various stages of medical care, etc. Additionally, the legal challenges arising from the use of big data and introduction of certain digital devices into medical practice are outlined, with special attention given to the brain-computer interface. Comprehensive recommendations for the improvement of healthcare legislation are presented.

Objective: To analyze the clinical and epidemiological characteristics in the post-pandemic influenza seasons in 2010/11/12/13 years. Material and methods: The analysis of the incidence of acute respiratory viral infections and flu in the Saratov region from 2009 to 2013. A clinical and laboratory examination of 252 patients with a diagnosis of «flu»: 152 pregnant women at different stages of pregnancy at the age of 18 years to 41 years and 100 children aged from 5 months to 14 years. The work was carried out to assess the epidemiological pattern and clinical course of influenza, and the effective operation of antiviral therapy. Results: In the post-pandemic period 2010-2013 simultaneously circulating influenza A viruses (N1N1/09) pd, influenza A (H3N2) and influenza B. In most cases, influenza in adults and children is of moderate form. All serious forms of influenza have been caused by influenza A with the development of viral-bacterial pneumonia, respiratory failure and neurotoxic syndrome. Late hospitalization and absence of antiviral therapy in the prehospital are at risk of severe and complicated forms. Conclusion: Early initiation of antiviral therapy is one of the main factors for the effectiveness of treatment and reduce the risk of influenza complications.

Background. Annual studies of West Nile virus (WNV) circulating in endemic areas are necessary to characterize its properties and track them over time. Given the lack of specific antiviral therapy for West Nile fever (WNF), it is of interest to study sensitivity to drugs widely used in modern practice. The aim of the study is to study the sensitivity of West Nile virus strains circulating in the Russian Federation in 2018–2021 to drugs used to treat viral infections.Material and methods. The sensitivity of WNV strains to ribavirin, riamilovir, and umifenovir was determined using Vero cell culture.Results and discussion. A study of the sensitivity of WNV strains circulating in the Russian Federation in 2018–2021 to therapeutic drugs used to treat viral infections showed their heterogeneity in this regard. Thus, 5 strains (WNV_Volgograd_601/18, Volgograd_723/18, Volgograd_830/18, Voronezh_794/21, Astrachan_962/21) out of 10 studied were characterized by some differences in resistance to ribavirin and riamilovir. No statistically significant differences were revealed when comparing drug resistance indicators of the group of WNV strains of the «old» genovariant with those of the «new» group.Conclusion. Further analysis of the genome of the studied WNV strains will allow us to establish genetic characteristics, which may contribute to the establishment of molecular mechanisms of resistance to ribavirin, riamilovir, and umifenovir.

Introduction. The rapid development of digital technologies has led to significant changes in various spheres of public life. The species classification of the modern world is based on the fact that the era of the information society is coming. Its characteristics were defined in the Okinawa Charter of the Global Information Society. Empirical analysis. The author presents an overview of the strategies for innovative technological development adopted in the Russian Federation under the influence of the development of digital technologies. The relevance of the formation of the concept of digital sovereignty is shown. The researcher conducted a comparative legal study which indicated that digital sovereignty was originally presented in the legal systems of the European Union countries. Foreign approaches to the formation of a new legal order, conditioned by the development of digitalization, are outlined. The article highlights the features of the German concept “Industry 4.0”, the Japanese concept “Society 5.0”, and the Chinese concept “Made in China 2025”. Theoretical analysis. The main trend of digitalization is decentralization, which affects not only the economies of countries, but also the public administration system. Its general consequences are highlighted: the emergence of competition between states (which leads to the expansion of axiology, and not just technology); a change in the concept of public administration in the context of growing horizontal connections (the emergence of the concept of “the state as a platform”); priority of data (in electronic form) as a condition for the economic, political and social development of the state. Results. The acceleration of the technological process has an impact on the socio-political sphere. The law does not have time to react to changes; the formed reality itself dictates those rules that are formed outside of political instruments. This also leads to the transformation of traditional state institutions, which forces us to rethink the very understanding of the modern state.

Due to the oncoming climate changes, various environmental stresses (drought, salinity, heavy-metals, low or high temperatures, etc.) might dramatically affect crop yields and the quality of produced foods. Therefore, to meet the growing food demand of the human population, improvement of stress tolerance of the currently cultured crops is required. The knowledge of the molecular underlying mechanisms provides a versatile instrument to correct plant metabolism via chemical tools and to thereby increase their adaptive potential. This will preserve crop productivity and quality under abiotic stress conditions. Endogenously produced nitric oxide (NO) is one of the key signaling factors activating stress tolerance mechanisms in plants. Thus, the application of synthetic NO donors as stress-protective phytoeffectors might support maintaining plant growth and productivity under stressful conditions. Sydnone imines (sydnonimines) are a class of clinically established mesoionic heterocyclic NO donors which represent a promising candidate group for such phytoeffectors. Therefore, here, we provide an overview of the current progress in the application of sydnone imines as exogenous NO donors in plants, with a special emphasis on their potential as herbicides as well as herbicide antidotes, growth stimulants and stress protectors triggering plant tolerance mechanisms. We specifically address the structure–activity relationships in the context of the growth modulating activity of sydnone imines. Growth stimulating or antidote effects are typical for 4-α-hydroxybenzyl derivatives of sydnone imines containing an alkyl substituent in position N-3. The nature of the substituent of the N-6 atom has a significant influence on the activity profile and the intensity of the effect. Nevertheless, further investigations are necessary to establish reliable structure–activity relationships (SAR). Consequently, sydnone imines might be considered promising phytoeffector candidates, which are expected to exert either protective effects on plants growing under unfavorable conditions, or herbicidal ones, depending on the exact structure.

Increased number of extreme weather events is one of the most serious hazards of climate change over the territory of Russia. However, there is a lack of comprehensive analysis of the number of extreme weather events that caused social and economic damage in the country and its regions. This paper analyzes changes in the total number of events with damage (meteorological for the period 1991-2019 and agrometeorological – for 2004-2019), disaggregated by their types and by regions. The Mann-Kendall test is applied to detect statistical significance (0.05 level of significance, normal distribution). The results show an increase in the number of meteorological extreme events with damage for 1990-2019 in Russia from 130 to 257 events per year on average for the 1990s and 2010s, respectively, while the proportion of events with damage in relation to the total number of extreme events decreased over this period. We found statistically significant trends only for a few types of extreme events: hot and cold temperature, strong wind, heavy rain and droughts (increase by 0.9, 9.4, 11.4, 25.9 and 13.3 events/10 years, respectively). Number of heavy rain precipitation events is the only unidirectional stable growth trend. Unusual increasing trend in cold extreme events with damage in Russia can be attributed to the greater damage to the economy and population from cold extremes than hot ones. The regional distribution of trends across the territory of the Russian Federation is heterogeneous. However, significant changes in the number of extreme events of strong winds, heavy rains and soil drought by regions are statistically positive and observed mostly in some southern and central regions of European part and the Western Siberia. The development of adaptation plans to the negative effects of climate change is a first priority for these regions. A system for monitoring economic and non-economic damage from extreme events must be developed in Russia.

SARS-CoV-2, the causal agent of the COVID-19 pandemic, is characterized by rapid evolution, which poses a significant public health challenge. Effective vaccines that provide robust protection, elicit strong immune responses, exhibit favorable safety profiles, and enable cost-effective large-scale production are crucial. The RBD-Fc-based Betuvax-CoV-2 vaccine has previously demonstrated a favorable safety profile and induced a significant anti-SARS-CoV-2 humoral immune response in clinical trials. Due to the rapid evolution and emergence of new SARS-CoV-2 strains, the relevance of bivalent vaccine formulations has increased. Methods: This study compared the neutralizing capacity of monovalent and bivalent vaccine formulations against different SARS-CoV-2 strains detected with a SARS-CoV-2 microneutralization assay (MNT). Findings: The monovalent Wuhan-based vaccine generated neutralizing antibodies against the Wuhan and Omicron BA.2 variants but not the distinct Omicron BQ.1 strain. Conversely, the monovalent BA.2-based vaccine induced neutralizing antibodies against both Omicron strains but not Wuhan. While the bivalent Wuhan and BA.2-based vaccine was effective against strains containing the same antigens, it was insufficient to neutralize the distinctive BQ.1 strain at a small dosage. Interpretation: These findings suggest that the vaccine composition should closely match the circulating SARS-CoV-2 strain to elicit the optimal neutralizing antibody response and include the appropriate dosage. Moreover, this study did not find additional advantages of using the bivalent form over the monovalent form for the vaccination against a single prevailing SARS-CoV-2 strain.

Objectives: This study aimed to determine the safety, tolerability and immunogenicity of TetraFluBet, an inactivated subunit influenza vaccine that contains a corpuscular immuno-adjuvant derived from natural betulin. Methods: We conducted a prospective, randomized, open-labeled, single-center, phase I trial. The study was conducted in two stages: 5 volunteers in stage I and 25 volunteers in stage II. Eligible participants received one single dose (20 μg/0.5 mL) of TetraFluBet intramuscularly. Participants were followed for adverse events and reactogenicity. Seroconversion rate, seroprotection level, geometric mean titers (GMTs) of virus-neutralizing antibodies, IFN-γ induction and cell-mediated immunity were assessed. Results: A total of 30 participants were enrolled. No vaccine-related serious adverse events were observed. The proportions of study participants with 4-fold seroconversions assessed by the HI assay (with 95% CIs) were 80.0% (62.7; 90.5), 70.0% (52.1; 83.3), 63.3% (45.5; 78.1) and 73.3% (55.6; 85.8) for influenza virus subtypes A (H1N1), A (H3N2), B1 and B2, respectively. Seroprotection levels (with 95% CIs) were 83.3% (66.4; 92.7), 83.3% (66.4; 92.7), 73.3% (55.6; 85.8) and 66.7% (48.8; 80.8), respectively. The fold increases in the GMTs of virus-neutralizing antibodies for subtype H1N1 was 6.50, for subtype H3N2 was 3.03, for subtype B1 was 3.56 and for subtype B2 was 6.07. The population of cytotoxic T-cells increased significantly in the post-vaccination period, indicating a strong CD3+CD8+ response. Conclusions: TetraFluBet tetravalent inactivated subunit vaccine with adjuvant demonstrated pronounced immunogenic properties, leading to the formation of both specific humoral and cellular immunity at a 20 μg dose.

Introduction. The legal aspects of state regulation of economic relations are of high relevance for the Russian Federation due to the development of modern crisis situations. At present, it is necessary to study the general parameters of the interaction between law and economics, on the basis of which it is possible to develop specific recommendations for improving Russian legislation. Empirical analysis. The author presents general factors that have a serious (in the long term) impact on the Russian economy: gradual decarbonization; the emergence of the concept of sustainable development, establishing a link between GDP growth (gross domestic product) and concern for future generations; universal digitalization affecting all spheres of public life. Methods and concepts. The confrontation between the two global currents of libertarianism and Keynesianism has a serious impact on the limits of state intervention in economic relations. At the same time, the gradual convergence leads to the development of such concepts as the social market economy and libertarian paternalism, each of them involving a transition to indirect influence and taking into account social factors in creating a competitive environment. The absence of a direct consolidation of the foundations of the economic system in the Constitution of Russia implies the development of synthetic principles that need further constitutionalization. Theoretical analysis. In the Russian Federation, the further strengthening of the direct role of the state in the country’s economy has institutionalgrounds – a large bureaucratic apparatus and a significant public sector in the economic system. At the same time, legal support for various forms of deregulation (self-regulation, co-regulation, quasi-regulation, etc.) has been formed. The declared "regulatory guillotine", in isolation from the general directions of administrative reform, is unlikely to have a significant long-term effect. Results. The process of deconcentration of power (with deregulation being one of the aspects) in the Russian Federation cannot be considered complete. Deregulation is not the only form of deconcentration and reduction of the administrative burden on businesses.

The study considers the impact on the person’s health and psycho-emotional state of unpleasant odors arising from the storage and accumulation of bioorganic waste, including food waste (meat, poultry, fruits and vegetables) and bird droppings. The survey data of poultry and livestock farms’ employees in Serbia are given. The impact of unpleasant odors on the Waste sorting complex (Moscow region) employees’ vital signs is assessed. The impact of high-intensity odor groups for individual components of food waste (pork meat, poultry meat, vegetables and fruits) and bird droppings was studied by interviewing volunteers and measuring their vital signs.

Background. The study discusses the key problems of organizing healthcare in the Russian Federation, as well as the prospects for their legal resolution due to the emer-gence of innovative technologies (biomedicine, genomic medicine, digital medicine). The transformation of the principle of patient autonomy is considered under the influence of such factors as increased praticipality in the organization of medical care, a change in ap-proaches in budgeting a healthcare organization, and the emergence of legal obligations in the field of protecting the health of citizens. The purpose of the study is to conduct a sys-tematic analysis of the legal regulation of medical activities. The correction of the under-standing of medical intervention as a type of service is substantiated. At the same time, it is shown that the model of allocating medical services should not be considered as a down-playing of the importance of medical care. Materials and methods. Research problems were solved through scientific analysis of a wide range of sources on the legal regime of medical activities. The method of system analysis was used, thanks to which the basic problems that arise in the process of implementing the concept of “medical service” were investigated: rejection by the medical community; inconsistency of the courts in resolving cases on the protection of consumer rights in the field of medical care; the presence of significant excep-tions (providing emergency assistance to a suicide, artificial termination of pregnancy, or-gan donation, cosmetic surgery, reproductive technologies). Results. The features of digital-ization of the healthcare system are shown. The formation of huge amounts of information creates additional difficulties, but also opens up new prospects for the development of pre-ventive medicine. Conclusions. The threats that arise due to the formation of information resources in the field of healthcare by various non-governmental non-medical organizations are highlighted. The article presents recommendations for improving legislation in the field of healthcare.

Despite the advances in pharmacology, there are still some patients with drug-resistant inoperable epilepsy. Individual ketogenic diet might be an effective measure to prevent seizures. A ketogenic diet must be used only after consulting a dietitian, since it has contraindications and may cause complications. This article focuses on the mechanism of action of the ketogenic diet, indications and contraindications to it, and also describes our experience of using ketogenic diet in a patient with structural focal epilepsy and a typical history of the disease, side effects of antiepileptic drugs, and low compliance of antiepileptic therapy.

As the focus of climate policy shifts from pledges to implementation, there is a growing need to track progress on climate change mitigation at the country level, particularly for the land-use sector. Despite new tools and models providing unprecedented monitoring opportunities, striking differences remain in estimations of anthropogenic land-use CO2 fluxes between, on the one hand, the national greenhouse gas inventories (NGHGIs) used to assess compliance with national climate targets under the Paris Agreement and, on the other hand, the Global Carbon Budget and Intergovernmental Panel on Climate Change (IPCC) assessment reports, both based on global bookkeeping models (BMs). Recent studies have shown that these differences are mainly due to inconsistent definitions of anthropogenic CO2 fluxes in managed forests. Countries assume larger areas of forest to be managed than BMs do, due to a broader definition of managed land in NGHGIs. Additionally, the fraction of the land sink caused by indirect effects of human-induced environmental change (e.g. fertilisation effect on vegetation growth due to increased atmospheric CO2 concentration) on managed lands is treated as non-anthropogenic by BMs but as anthropogenic in most NGHGIs. We implement an approach that adds the CO2 sink caused by environmental change in countries' managed forests (estimated by 16 dynamic global vegetation models, DGVMs) to the land-use fluxes from three BMs. This sum is conceptually more comparable to NGHGIs and is thus expected to be quantitatively more similar. Our analysis uses updated and more comprehensive data from NGHGIs than previous studies and provides model results at a greater level of disaggregation in terms of regions, countries and land categories (i.e. forest land, deforestation, organic soils, other land uses). Our results confirm a large difference (6.7 GtCO2 yr−1) in global land-use CO2 fluxes between the ensemble mean of the BMs, which estimate a source of 4.8 GtCO2 yr−1 for the period 2000–2020, and NGHGIs, which estimate a sink of −1.9 GtCO2 yr−1 in the same period. Most of the gap is found on forest land (3.5 GtCO2 yr−1), with differences also for deforestation (2.4 GtCO2 yr−1), for fluxes from other land uses (1.0 GtCO2 yr−1) and to a lesser extent for fluxes from organic soils (0.2 GtCO2 yr−1). By adding the DGVM ensemble mean sink arising from environmental change in managed forests (−6.4 GtCO2 yr−1) to BM estimates, the gap between BMs and NGHGIs becomes substantially smaller both globally (residual gap: 0.3 GtCO2 yr−1) and in most regions and countries. However, some discrepancies remain and deserve further investigation. For example, the BMs generally provide higher emissions from deforestation than NGHGIs and, when adjusted with the sink in managed forests estimated by DGVMs, yield a sink that is often greater than NGHGIs. In summary, this study provides a blueprint for harmonising the estimations of anthropogenic land-use fluxes, allowing for detailed comparisons between global models and national inventories at global, regional and country levels. This is crucial to increase confidence in land-use emissions estimates, support investments in land-based mitigation strategies and assess the countries' collective progress under the Global Stocktake of the Paris Agreement. Data from this study are openly available online via the Zenodo portal (Grassi et al., 2023) at https://doi.org/10.5281/zenodo.7650360.

Research reveals the legal problems that arise due to the rapid pace of development of additive technologies (3D printing) in biomedicine (bioprinting). The purpose of the research is to analyze the legislation that defines the legal regime of additive technologies, identify the main gaps in regulation, carry out a comparative legal study, which allows to formulate recommendations to improve Russian legislation. Special strategies are used as an object of comparative research; they contribute to fix the priority development of 3D printing. The employed methods are as follows: the method of analysis of legal regulation, comparative legal and formal legal. Results. Attention is paid to the main trends and risks of progress in this direction, which are reflected in decentralization of production; improving its efficiency and reducing waste; reduction of development time and their introduction into mass production with a simultaneous rise in quality of the finished product; expanding the population's access to material goods; minimizing the state control. Particular attention is paid to the legal assessment of the applicability of bioprinting in transplantology, the manufacture of implants, surgical planning, and the use of printed organs for experiments. Conclusions: when adjusting the legal framework, institutional readiness should be taken into account - the ability of the entire Russian healthcare system to use additive technologies properly (which will require significant changes in healthcare legislation). An independent direction is the use of bioprinting in the testing of drugs. 3D printing creates small organ-like structures (they are called organoids) on which experiments can be carried out for the screening of pharmaceuticals. This will require changes in the legal regime for the circulation of medicines, as well as the main functions of the state regulator (the Russian Ministry of Health and Roszdravnadzor). It is noted that additive technologies make it possible to manufacture medicines, but world experience indicates a cautious attitude towards this type of production. Research argues for the need to follow a risk-based approach in the legal regulation of bioprinting, as well as to introduce the general approach of Hospital Exemption (pharmaceutical exclusion) used in the countries of the European Union, as well as some other countries aimed at the development of regenerative medicine.

Pulmonary aspergillosis has always been considered as a disease that occurs in patients with certain risk factors for its development. The COVID-19 pandemic has shown that fungal complications are common in patients without aspergillosis risk factors. Thus, invasive aspergillosis is a common complication of COVID-19. There are rare reports of aspergilloma that developed after a severe coronavirus infection in individuals who did not previously have cavitary lesions in the lungs. Development of aspergilloma as an expected long-term complication after COVID-19 may be due to damage of lung structure caused by coronavirus infection, oxygen therapy and mechanical ventilation. This article describes a case report of aspergilloma in a patient with confirmed severe COVID-19 and background chronic diseases without risk factors for fungal infection. A review of publications on the development of aspergilloma in patients following COVID-19 is also presented.