Survival prediction in triple-negative breast cancer: a Cox model with fairness assessment using ISO/IEC TR 24027:2021 in a MENA cohort

Whilst the prevalence of obesity has rapidly increased in the Middle East and North Africa (MENA) and Latin America and the Caribbean (LAC) regions, child undernutrition remains a public health challenge. We examined region‐specific sociodemographic determinants of the co‐occurrence of within‐child stunting and overweight using the most recent Demographic and Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) data (2004‐2013) from 8 countries in the MENA (n=103,879) and 8 countries in the LAC (n=49,918) regions. We used multiple logistic regression to model country‐ and region‐specific associations of sex, maternal education, household wealth, and area of residence with stunting, overweight and the co‐occurrence of within‐child stunting and overweight in children aged 6‐59 months. The prevalence of stunting, overweight, and their co‐occurrence within children in the MENA and LAC regions respectively, were 21% and 17%; 12% and 6.9%; and 6.1% and 1.3%. In both regions, higher maternal education and household wealth were associated with lower odds of stunting and higher odds of overweight. Post‐secondary education among mothers (OR (95% CI): 0.62 (0.43, 0.90)) and greater household wealth (0.52 (0.30, 0.90)) were associated with a lower odds of concurrent child stunting and overweight in the LAC region but not the MENA region. Stunted‐overweight children were more likely to be boys in both regions. There was no association between rural/urban residence and any nutritional outcomes in either region. Child stunting and overweight coexist throughout the MENA and LAC regions, and cross urban/rural and sociodemographic divides.

PurposeThis article explores the current trends in civic engagement in the Middle East and North Africa (MENA) region after a decade of social media growth in the region.Design/methodology/approachThe methodology is based on a case studies approach. In these case studies, the authors use an exploratory approach to case study research. The authors employ a mixed-method approach to exploring the development of civic engagement in the MENA region.FindingsThe study’s finding shows that the MENA region's social media growth has enabled digital natives to play a vital role in enriching and empowering their communities and their lives.Research limitations/implicationsThe paper could have explored more examples from around the MENA region.Practical implicationsThe paper's practical significance is the understanding that the ground is shifting around Internet access and how digital natives in the MENA region are employing it for their civic engagement initiative. It is an important indication that the MENA region's next innovation could be in the civic engagement arena. Unlike their parents, who are digital immigrants, these young and energetic digital natives are out to shape all aspects of their lives. Paving the way for more innovative and creative ways of civic engagement in the MENA region.Originality/valueThe paper explores civic engagement development in the MENA region, shedding light on the issues concerning MENA region youth such as cleaning the environment, waste and food recycling, combating extremism, developing education curricula and even promoting peace. The paper's value is that it gives an update on civic engagement in the MENA region.

BackgroundDonor countries in the Middle East and North Africa (MENA) including Saudi Arabia, Kuwait and United Arab Emirates (UAE) have been among the largest donors in the world. However, little is known about their contributions for health. In this study, we addressed this gap by estimating the amount of development assistance for health (DAH) contributed by MENA country donors from 2000 to 2017.MethodsWe tracked DAH provided and received by the MENA region leveraging publicly available development assistance data in the Development Assistance Committee (DAC) database of the Organisation for Economic Co-operation and Development (OECD), government agency reports and financial statements from key international development agencies. We generated estimates of DAH provided by the three largest donor countries in the MENA region (UAE, Kuwait, Saudi Arabia) and compared contributions to their relative gross domestic product (GDP) and government spending; We captured DAH contributions by other MENA country governments (Egypt, Iran, Qatar, Turkey, etc.) disbursed through multilateral agencies. Additionally, we compared DAH contributed from and provided to the MENA region.ResultsIn 2017, DAH contributed by the MENA region reached $514.8 million. While UAE ($220.1 million, 43.2%), Saudi Arabia ($177.3 million, 34.8%) and Kuwait ($59.8 million, 11.6%) as sources contributed the majority of DAH in 2017, 58.5% of total DAH from MENA was disbursed through their bilateral agencies, 12.0% through the World Health Organization (WHO) and 3.3% through other United Nations agencies. 44.8% of DAH contributions from MENA was directed to health system strengthening/sector-wide approaches. Relative to their GDP and government spending, DAH level fluctuated across 2000 to 2017 but UAE and Saudi Arabia indicated increasing trends. While considering all MENA countries as recipients, only 10.5% of DAH received by MENA countries were from MENA donors in 2017.ConclusionMENA country donors especially UAE, Saudi Arabia and Kuwait have been providing substantial amount of DAH, channeled through their bilateral agencies, WHO and other multilateral agencies, with a prioritized focus on health system strengthening. DAH from the MENA region has been increasing for the past decade and could lend itself to important contributions for the region and the globe.

The Middle East and North Africa (MENA) region has unique characteristics compared to other regions in the world, such as Asia, the US, and Europe, including fewer natural disasters but more conflicts that lead to wars, which can significantly impact the Indonesian diaspora communities residing in the area. Indonesian citizens need to prepare to anticipate crises that require good strategies and collaboration involving the diaspora and the Indonesian government. This research aims to explore the importance of crisis management strategies for the Emergency Response Team (ERT) of the Indonesian diaspora in MENA. This study utilizes a qualitative approach involving in-depth interviews with experts, competent individuals, or members of the Indonesian diaspora ERT in the MENA region. Both primary and secondary data will be collected and analyzed using the Soft Systems Management (SSM) analysis method. Analysis using brainstorming and PESTLE will also be conducted to assist decision-making, as well as Incident Management Systems. The research will also identify challenges faced by the Indonesian Diaspora Emergency Response Team, the Embassy of the Republic of Indonesia, and the Indonesian Community Association in facing crises in the MENA region and analyze effective crisis management strategies that can be used to enhance readiness and response to emergency situations. This includes analysis and case studies on the evacuation of Indonesian citizens due to crises in Yemen, Libya, and Tunisia. The results of this study are expected to develop an understanding of crisis management for the Indonesian diaspora in MENA and provide practical recommendations to strengthen their ERT capacity in dealing with emergency situations, both in MENA and other regions. This study emphasizes the importance of proactive, network-based, and stakeholder engagement strategies and provides useful insights for policy-making and emergency response planning for the Indonesian diaspora community.

PurposeThis study aims to investigate the factors contributing to the low adoption rate of mobile money services (MMS) in the Middle East and North Africa (MENA) region compared to other regions. The study focussed on socio-demographic factors and macro-level determinants in several selected MENA and Sub-Saharan African (SSA) regions where MMS have been successful.Design/methodology/approachThis study analysed 23 countries across MENA and SSA to establish the correlation between socio and macroeconomic factors and MMS adoption using a quantitative approach. The analysis used the generalized least square (GLS) method.FindingsThe study revealed that gender and income are factors that positively influence the adoption of MMS in MENA and SSA regions. Additionally, the study found that the affordability index, which measures macroeconomic indicators, correlates with MMS adoption in both regions but in an inversed way. On the other hand, political stability appears to have a positive correlation with MMS adoption in the MENA region. The correlation between the regulatory index and MMS adoption positively impacts the entire study group, although it is insignificant in the SSA region.Research limitations/implicationsFuture studies should assess market competition among MMS providers and the psychological aspect of user adoption behaviour. Additionally, conducting a focus group discussion with stakeholders in the MMS industry can assist in uncovering potential factors contributing to low MMS adoption in the MENA region.Originality/valueThis study contributes to understanding the role of the socio-demographic and macroeconomic determinants in promoting digital transformation through adopting MMS.

PurposeSustainability focuses on the effect of present actions on societies, environments and ecosystems of the future. The purpose of this paper is to discover to what extent the MENA (Middle East and North Africa) region corporations carry out various aspects of corporate sustainability. This paper studies corporate sustainability practices and examines the association between corporate sustainability practices and performance in the MENA region.Design/methodology/approachA thorough literature review was conducted. The findings indicate six key categories/constructs that can be used as indicators for measuring corporate sustainability and performance. Based on the literature review, a theoretical framework was constructed and tested. Data for this quantitative and explanatory study were obtained through a self-administered survey which was distributed to senior managers at corporations in the MENA region.FindingsThe findings of this study show that the corporations operating in the MENA region are underachieving in all aspects of sustainability except for the energy management facet. Larger-sized companies tend to be more involved in corporate sustainability practices in the categories of internal and external education, external health and resources and energy management. This study finds the existence of a strong positive relationship between each sustainability category and each performance category.Originality/valueMost studies on sustainability focus on North America, Europe and East Asia, not the MENA region. The findings will help corporations in the MENA region become aware of the importance of increasing their engagement in the sustainability aspects that they lack, as this will lead to a boost of their overall performance.

e24105 Background: Cancer care has been severely affected by covid 19 pandemic leading to medical, ethical and organizational issues. Oncology healthcare professionals face challenges due to reorganization of cancer services and increasing health care requirements resulting in uncertainty and psychological stress. Aim of this study is to evaluate the impact of covid 19 pandemic on psychological well being of oncology clinicians in the MENA region. Methods: We randomly invited 1500 oncology clinicians including medical oncologists, clinical oncologists, radiation oncologists and surgical oncologists from 17 countries in the MENA region to complete a web based survey to determine the level of psychological stress during covid 19 pandemic from October 2020 to January 2021. The questionnaire was based on Perceived Stress Scale (PSS), Generalized Anxiety Disorders Scale (GAD-7) and WHO Well-being Index (WHO-5). The data was analyzed using SPSS version 21 and difference between groups was measured by T-test and ANOVA. Results: Overall 520 (35%) oncology clinicians including 368 (71%) males and 152 (29%) females participated in the survey. Most of the participants were medical oncologists (38%) from teaching institutions (76%) and the public sector (84%). 46% (n = 242) participants were 35-45 years of age. Majority of clinicians reported moderate (45.6%) to severe (42.3%) anxiety on GAD-7 scale. Females had statistically higher levels of anxiety (average score;15.46 ±4.87, p = 0.04). On PSS, the majority of participants reported higher stress with average scores (29.64 ±3.83) for males and (30.23 ±4.62) for females. Average score for WHO wellbeing index was 62.95 (±20.52) for males and 74.3 (±20.87) for females denoting a preservation of general well being, even in a higher stress and anxiety situation. Female gender was significantly associated with anxiety level on GAD-7 scale (p = 0.04), but this difference in stress level and well being was not observed on PSS (p = 0.134) and WHO well being index (p = 0.709). Clinicians of ages 25-35 years had significantly higher anxiety levels on GAD-7 scale (p = 0.004) and higher stress on PSS (p = 0.000). Age over 55 years was associated with lower levels of anxiety and stress on GAD-7 and PSS. Oncology clinicians working in public sector experienced significantly lower stress as compared to private sector on PSS scale (p = 0.041) Conclusions: Covid 19 pandemic has significantly increased the anxiety and stress levels among oncology clinicians in the MENA region. Anxiety and stress were higher in females and young clinicians. Clinicians over 55 years of age and oncologists working in the public sector reported less stress and anxiety. General well being of clinicians was well preserved even in a highly stressful and anxious situation.

The Middle East and North Africa (MENA) region is at a turning point in its development. How MENA region addresses the employment needs of its rapidly increasing population of young people will determine whether the MENA region will become a region characterized by stable, knowledge-based economies that have a dynamic working middle class. Entrepreneurship is considered vital to drive this transition of MENA region. Increased entrepreneurial activities will not only spur job growth but also generate ideas, attract investment and inspire future entrepreneurs to follow footsteps of successful entrepreneurs. This chapter explores the entrepreneurial ecosystem of MENA region. The chapter discusses various challenges and provides specific recommendations to boost entrepreneurial activities in MENA region.

PurposeThis paper aims to investigate the impact of capital requirements and bank competition on banks' risk-taking behavior in the Middle East and North Africa (MENA) region.Design/methodology/approachThe study combines both descriptive and analytical approaches. It considers panel data sets and adopts panel data econometric techniques like fixed effects/random effects and generalized method of moments estimator.FindingsRegulatory capital and market competition have different effects according to the bank’s type (Islamic or conventional). The results show that the capital adequacy ratio has a significant impact on the credit risk of conventional banks (CBs) while this effect is irrelevant for Islamic banks (IBs). However, market competition plays a significant role in shaping risk-taking behavior of Islamic banking institutions. Our results indicate that banks with strong market power may pursue risky strategies in the face of increased regulatory pressure (e.g. increased minimum capital requirements). The results were robust to alternative profitability measures and endogeneity checks.Research limitations/implicationsThe most important limitation is the lack of data for some banks and years, and this paper had to exclude some variables because of missing observations. The second limitation concerns the number of IBs in the sample. However, this can be overcome by including more countries from MENA and other regions where Islamic banking is a growing phenomenon.Practical implicationsOur findings call for a change in Islamic banking’s traditional business model based on the prohibition of interest. The analysis indicates that market concentration moderates the association between capital requirements and the insolvency risk of IBs but not CBs. Therefore, regulatory authorities concerned with improving financial stability in the MENA region should set up their policies differently depending on the level of banking market concentration. Finally, bank managers are requested to apply a more disciplined approach to their lending decisions and build sufficient capital conservation buffers to limit the impact of downside risk from the depletion of capital buffers during the pandemic.Originality/valueThis study addresses banks’ risk-taking behavior and stability in the MENA region, which includes banks of different types (Islamic and conventional). This paper also contributes to the literature on bank stability by identifying the most critical factors that affect bank risk and stability in the MENA region, which can be relevant in the context of the new global (COVID-19) crisis.

Supply curves of electricity-based gaseous fuels in the MENA region

Background: Head and neck cancer (HNC) is associated with tobacco or heavy alcohol use and chronic human papillomavirus (HPV) infection. Aims and Objectives: In this systematic review and meta-analysis, we determined the HPV-associated HNC prevalence rates and potential factors affecting prevalence rates in the Middle East and North Africa (MENA) region. Materials and Methods: Between July and August 2019, we searched and collected 38 articles from PubMed and Medline databases related to head and neck squamous cell carcinoma and HPV in the MENA region. Of those articles, 25 met the inclusion criteria. Results: The overall pooled HPV prevalence rate of all HNC cases reported in the MENA region was 16% (confidence interval 95%, 12%–21%). HPV was found primarily in the salivary glands (20%) and tonsils (16%). The characteristics of patients associated with HPV-driven HNC were being male, having a benign tumor, and using tobacco. The genotypes most strongly associated with HNC in the MENA region were HPV-16 followed by HPV-18. The highest reported prevalence rates of HPV-associated HNC were in Turkey (48%) and Palestine-Israel (31%), whereas the lowest were in Yemen (2%) and Saudi Arabia (4%). HNC-associated HPV prevalence decreased over time in the MENA region, from 19% during 1998–2010 to 15% during 2011–2014 to 12% during 2015–2019. Conclusion: Although the current prevalence of HPV-associated HNC in this region is low relative to rates observed elsewhere, HNC is typically fatal, and a global rise in HPV-driven HNC indicates that additional studies should be conducted in the MENA region to address this risk and to develop HPV awareness, screening, and vaccination programs.

Current developments in the field of micro-nano technologies in the Middle East and North Africa (MENA) region are highlighted. Firstly, the scientific outcome of micro-nano technologies from the MENA region is analyzed. Egypt and Saudi Arabia are the leading countries, with >50% of the total MENA publications. More than 50% were joint publications with France and the United States as the major partners. Secondly, different kinds of existing initiatives to develop and support micro-nano technologies in the MENA region are presented. The working principle of current respective initiatives is demonstrated. Despite the importance of these initiatives, they are fragmented and lack a regional framework and a common goal. Thirdly, therefore, a recommendation is suggested to create a platform and a road map for boosting the development of micro-nano technologies in the MENA region.

Sustainability and energy self-sufficiency; overcoming the barriers

Infection with the hepatitis C virus (HCV) remains a considerable public health concern in the Middle East and North Africa (MENA). The objectives of this study were to analyze the HCV genotype (GT) and sub-genotype (SGT) distribution in the MENA region and to assess the temporal change in the number of sequences within the MENA region. All HCV molecular sequences collected in the MENA region had been retrieved from GenBank as of 1 August 2022. The number of HCV sequences retrieved was 6740 representing sequences from a total of 17 MENA countries with a majority from Iran (n=1969, 29.2%), Egypt (n=1591, 23.6%), Tunisia (n=1305, 19.4%) and Saudi Arabia (n=1085, 16.1%). The determination of GT/SGT was based on the NCBI genotyping and Blast tool. Genotype 1 (GT1) dominated infections in the MENA (n=2777, 41.2%), followed by GT4 (n=2566, 39.0%). Additionally, SGT4a (1515/6393, 23.7%) was the most common SGT in the MENA, and SGT4a was dominant in Egypt and Saudi Arabia, followed by SGT1b (n=1308, 20.5%), which was dominant in Morocco and Tunisia, while SGT1a (n=1275, 19.9%) was common in Iran, Iraq and Palestine. Furthermore, significant temporal increase in the number of HCV MENA sequences was observed. On the SGT level, specific patterns of HCV genetic diversity were seen in the MENA region, with the most common SGT being 4a, in addition to increasing the availability of HCV sequences in the MENA region.

Triple-negative breast cancer (TNBC) accounts for approximately 10-20% of all diagnosed breast cancer. Both epidermal growth factor receptor (EGFR) and vascular endothelial growth factor receptor 2 (VEGFR2) frequently overexpress in TNBC and cooperate with each other in autocrine and paracrine manner to enhance tumor growth and angiogenesis. Therapeutic mAbs targeting EGFR (cetuximab) and VEGFR2 (ramucirumab) are approved by FDA for numerous cancer indications, but none of them are approved to treat breast cancers. TNBC cells secrete VEGF-A, which mediate angiogenesis on endothelial cells in a paracrine fashion and promote cancer cell growth in autocrine manner. To disrupt autocrine/paracrine loop in TNBC models in addition to mediating anti-EGFR tumor growth signaling and anti-VEGFR2 angiogenic pathway, we generated a bispecific antibody co-targeting EGFR and VEGFR2 (designated as anti-EGFR/VEGFR2 BsAb), in which cetuximab IgG backbone is connected to the single chain variable fragment (scFv) of ramucirumab via a glycine linker. Physiochemical characterization data shows that anti-EGFR/VEGFR2 BsAb binds to both EGFR and VEGFR2 in a similar binding affinity comparable to parental antibodies. Anti-EGFR/VEGFR2 BsAb demonstrates potent in vitro and in vivo anti-tumor activity in TNBC models. Mechanistically, anti-EGFR/VEGFR2 BsAb not only directly inhibits both EGFR and VEGFR2 in TNBC cells but also disrupts autocrine mechanism in TNBC xenograft mouse model. Furthermore, anti-EGFR/VEGFR2 BsAb blocks paracrine pathway mediated by VEGF/VEGFR2 in endothelial cells. Collectively, our novel findings demonstrate that anti-EGFR/VEGFR2 BsAb inhibits tumor growth via multiple mechanisms of action and has potential to be developed as an attractive targeted therapy for TNBC. Citation Format: Nishant Mohan, Xiao Luo, Yi Shen, Zachary Olson, Atul Agrawal, Yukinori Endo, David Rotstein, Lorraine Pelosof, Wen Jin Wu. Physiochemical and biological characterization of anti-EGFR based bispecific antibodies in triple negative breast cancer (TNBC) models [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5310.