Global Regions Research Articles

A Late/Post-Imperial Region of Difference: The Ottoman Empire and its Successor Polities in Southeastern Europe, Turkey, and the Arab East, c. 1850s–1940s

Abstract: This text links the literatures on late/post-Ottoman history and on supranational regions. It argues that the area corresponding to the Ottoman Eurasian provinces before the empire’s step-by-step modern-time contraction became a region in the 1850s–1940s. Two processes pulled this region together: sovereignty contests and state-building impacts between the shrinking empire, nascent post-Ottoman nation-states, and interventionist European empires. While shifting around 1920, the region persisted until these two processes waned in the 1940s. The two processes were entwined. They shared a bedrock: the fact that the empire’s premodern religio-ethnic heterogeneity became an issue in modern times, encouraging homogenization. A centrifugal process—the disintegration of the Ottoman “Empire of Difference”—had a centripetal effect: a late/post-imperial region of difference united by the ricocheting impacts of homogenization, persisting “minority” populations, and meddling states, including European empires. Our case helps revisit supranational regions. Compared, for example, to world or global regions, external actors played a more direct part in “our” region; it was short and had a transformative rhythm; and it was characterized not by relatively ordered commonality but by joint volatile differences. Hence, this case forms part of, and illustrates, a broader pattern of modern Eurasian and European empires’ disintegration, which did not just usher in neatly separate nation-states.

A Northgrippian sedimentary magnetic enhancement along the western margin of India

Sedimentary magnetic records of shelf region contains complex environmental evolution information, necessitating records from various global regions to accurately interpret its significance. A sediment core (SSD-39/GC-01) retrieved from the eastern Arabian Sea was analyzed to elucidate the geologic and climatic controls on the sediment rock magnetic and grain size properties. We report the first record of high energy sediment deposits linked with intense monsoon phases, sea level variations, and extreme natural events during the Northgrippian period (8.27 ka to 4.20 ka). The compilation of magnetic susceptibility profiles of six sediment cores from the western margin of India revealed the presence of multiple sedimentary intervals of enhanced magnetic susceptibility and most likely reflect periods of high sedimentation events controlled by the regional geologic and climatic processes. We identified two anomalous sedimentary magnetic zones (Z-II, Z-IV) marked by an elevated magnetite content and sediment grain size, which reflect the periods of high-sedimentation events on the shelf off Goa. A shift in the magnetic mineral composition, clastic grain size, calcium carbonate, and organic carbon content at ~1.8 ka (Z-I) indicate a abrupt change in monsoon intensity. The elevated organic content within Z-I indicate efficient preservation of labile organic matter which survived oxidation due to rapid sediment deposition. End-member modeling of rock magnetic and grain size properties enabled us to discriminate and quantify the contributions of terrigenous fluxes and post-depositional mineral phases to the bulk magnetic mineral assemblage. We demonstrate that rapid scanning of magnetic susceptibility of sediment cores has the potential to precisely detect the periods of increased continental (magnetic flux) inputs into the marine shelf system. The proposed magnetic mineralogical approach has wider scope to constrain the understanding of how shelf sedimentation responded to past geological and climatic conditions globally.

Pathotype Identification and Host Resistance Evaluation of Clubroot in Zhejiang Province, China.

Clubroot, caused by Plasmodiophora brassicae, is a globally destructive soil-borne disease affecting cruciferous plants. Here, the predominant pathotypes of P. brassicae in six cities within Zhejiang Province were identified using the Williams and European Clubroot Differential (ECD) systems. A phylogenetic analysis of P. brassicae isolates infecting cruciferous crops worldwide was conducted using MEGA, and their ITS2 secondary structures were predicted through the ITS2 database. Accessions of B. rapa, B. oleracea, B. juncea, and Eruca sativa Mill. were employed to assess clubroot resistance. The results revealed that the prevalent pathotypes in Zhejiang Province were pathotype 1, ECD20/31/12 and ECD24/16/30; pathotype 3, ECD20/15/4; pathotype 8, ECD16/0/0 and ECD24/0/0; and pathotype 2, ECD16/15/15. Isolates from distinct genera of Brassicaceae formed separate branches in the evolutionary tree. Moreover, isolates of Brassica crops from Zhejiang Province exhibited homology with those from other global regions, a finding corroborated by their ITS2 secondary structure. Approximately 80% and 95% of B. rapa and B. juncea crops displayed susceptible phenotypes for pathotype 8, ECD16/0/0, whereas approximately 60% of B. oleracea crops exhibited resistance. Furthermore, three Brassica crop accessions showed significant variation in resistance to the pathogen, both among morphological and geographical origin groups. This study contributes to understanding the distribution of diverse P. brassicae pathotypes in different regions of Zhejiang Province and facilitates the identification of Brassica crops with potential disease resistance suitable for cultivation in the province.

Normal Gut Microbiomes in Diverse Populations: Clinical Implications

The human microbiome is a sensor and modulator of physiology and homeostasis. Remarkable tractability underpins the promise of therapeutic manipulation of the microbiome. However, the definition of a normal or healthy microbiome has been elusive. This is in part due to the underrepresentation of minority groups and major global regions in microbiome studies to date. We review studies of the microbiome in different populations and highlight a commonality among health-associated microbiome signatures along with major drivers of variation. We also provide an overview of microbiome-associated therapeutic interventions for some widespread, widely studied diseases. We discuss sources of bias and the challenges associated with defining population-specific microbiome reference bases. We propose a roadmap for defining normal microbiome references that can be used for population-customized microbiome therapeutics and diagnostics.

Spatiotemporal Variability and Trend of Ozone Pollution from Satellite Data (2003- 2021) in Iraq

Ozone (O3) occurs naturally in the Earth's upper atmosphere, and at ground level is a dangerous pollutant hurts plants and lung tissue and it’s a major component of smog. The purpose of this study to analyze the time series, trend, and spatial-temporal changes of monthly Relative Humidity (RH), Outgoing Longwave Radiation (OLR), and O3 in Iraq using the Atmospheric Infrared Sounder (AIRS) ascending AIRS3STM data during 2003 - 2021. The time series over six stations (Mosul, Sulaymaniyah, Khanaqin, Rutba, Baghdad, and Basra) have been analyzed and showed similar changes and fluctuation in O3 and OLR. The results of the study obtained were: minimum (decreasing, January–December) and maximum (increasing, May–August), and the mean and standard deviation were (0.044±0.003 ppmv) for O3 and (298± 22 Wm-2) for OLR during the study period. During December to February, the highest RH values were recorded, while the lowest RH values occurred from June to August. The monthly mean and standard deviation of RH was (28.66±29.54 g/kg). Further O3 trends revealed negative results in their annual series over all stations, except for Khanaqin and Basra, which had a positive trend. The O3 concentrations were consistently connected with other meteorological variables (the O3 has a negative correlation with RH and a beneficial correlation with temperature). The O3 spatiotemporal maps showed recorded the highest values recorded in April and May over Mosul and Sulaymaniyah (0.055–0.057), and in December, at middle and southern regions (Baghdad and Basra), there were the lowest O3 value (0.033). These results were due to meteorological and geographical factors. The results showed the efficient use of AIRS data to analyze the variations and distributions of atmospheric factors over different regions. In addition, AIRS observations can be used to obtain atmospheric, climatic, and environmental scientific reports and analyses for large, regional, and global regions and for long, continuous periods.

Mapping the Trade Direction of Indian Rice with Markov Chain Analysis

Agriculture is a cornerstone of India’s economy, with rice being a critical crop that ranks second globally, feeding over half of the world’s population and serving as a staple in Southeast Asia. This study explores the direction of India’s rice trade using Markov Chain Analysis, following an examination of the compound annual growth rate (CAGR) in rice exports to various global regions. Results reveal a 2.26 per cent CAGR in rice production, while export values surged by 16.8 per cent annually. Specifically, the CAGR for rice exports to Iraq and Iran reached 58.6 per cent and 46.47 per cent, respectively. In quantity, India’s rice exports grew by 10.82 per cent, with Iraq and Iran at 44 per cent and 34 per cent. The Transitional Probability Matrix for 2001-2022 indicates strong regional retention, with Africa maintaining 78 per cent of trade value and Asia 93.7 per cent, and similar trends in quantity, where Asia retained 92.6 per cent and Africa 89.1 per cent. These findings highlight India’s potential to diversify rice exports and strengthen its global competitive edge, urging a focus on enhancing processing, transportation, and quality standards for wider market appeal.

Understanding the Global Distribution of Groundwater Sulfate and Assessing Population at Risk.

Besides sulfate-induced diarrhea, recent studies have emphasized that groundwater sulfate drives the release of arsenic in groundwater and accelerates water pipeline corrosion. Despite its impact on public health and urban infrastructure, sulfate has been overlooked in water supply research. Here, we used a random forest model to develop a 1 km global map depicting the probability of sulfate exceeding 250 mg/L in groundwater based on the World Health Organization's guidelines. The map was further applied to estimate the exposed population and identify contributors of sulfate exceedance in global hotspot regions. The results revealed that sulfate exceedance in groundwater was widespread in 156 countries. Approximately 194 million people use water with sulfate levels exceeding 250 mg/L. Among them, around 17 million people face groundwater sulfate concentrations surpassing 500 mg/L, with 82% of these individuals residing in ten specific countries. Contributing factor analysis in these countries indicates that annual precipitation and sedimentary rocks are the primary factors contributing to sulfate concentration prediction, while other natural and anthropogenic predictors exhibit region-specific impact patterns. This study uncovered a significant prevalence of elevated sulfate levels in groundwater, highlighting the need to integrate sulfate into water safety management practices.

Uneven global retreat of persistent mountain snow cover alongside mountain warming from ERA5-land

The warming of mountains has become evident in recent years, with a mean global warming rate of 1.19 °C from 1979 to 2022. However, unveiling the global divergent decline of persistent mountain snow cover in the face of climate shifts remains unexplored. However, the global decline of persistent mountain snow cover due to climate change is not well understood. This study uses reanalysis and satellite data to examine changes in snow cover lasting over six months across our global mountain regions. We reveal a significant global mean decline of 7.79% in persistent snow cover over the past 44 years. The regional snow cover trends exhibit a heterogeneous and non-linear response to its regional warming rate. Our findings highlight the interplay between global warming and snow cover, emphasizing the need for sustainable development strategies to address the potential impacts of diminishing mountain snow.

Chinese Entrepreneurship and Russian-Chinese Border Development in the Context of Global Regionalism

Chinese Entrepreneurship and Russian-Chinese Border Development in the Context of Global Regionalism

Global Epidemiology of Meningococcal Disease-Causing Serogroups Before and After the COVID-19 Pandemic: A Narrative Review.

Invasive meningococcal disease (IMD) is associated with high morbidity and mortality and predominantly caused by five Neisseria meningitidis serogroups (A/B/C/W/Y). Polysaccharide conjugate vaccines induce T-cell-dependent immune responses, are immunogenic in infants and adults, and reduce carriage, and vaccination of age groups associated with high-carriage can provide indirect protection in the unvaccinated (herd immunity). Successful vaccination programs must be tailored to local epidemiology, which varies geographically, temporally, and by age and serogroup. Serogroup A IMD once predominated globally, but has largely disappeared following mass vaccination programs. Serogroup B was a predominant cause of IMD in many global regions from 2010 to 2018, typically affecting younger age groups. Spread of serogroup C clonal complex-11 IMD in the 1990s prompted implementation of MenC vaccine programs in many countries, resulting in declines in prevalence. Serogroup C still caused>20% of global IMD through the mid-2010s. Serogroup W became a significant contributor to global IMD after Hajj pilgrimage outbreaks in 2000; subsequent increases of endemic disease and outbreaks were reported pre-pandemic in many regions. Serogroup Y emerged in the 1990s as a significant cause of IMD throughout various regions and prevalence had increased or stabilized from 2010 to 2018. Serogroup X is uncommon outside the African meningitis belt, and its prevalence has declined since before the COVID-19 pandemic. Global IMD declines during the pandemic were followed by resurgences generally caused by serogroups that were prevalent pre-pandemic and affecting mainly unvaccinated age groups (particularly adolescents/young adults). Recent IMD epidemiology underscores the importance of vaccinating at-risk age groups against regionally prevalent serogroups; for example, the anti-serogroup X component of the recently prequalified MenACWXY vaccine is likely to provide limited protection outside the African meningitis belt. In other regions, comprehensive vaccination against MenB and MenACWY, which could be streamlined by the recently approved MenABCWY vaccine, seems more appropriate.

Global, regional, and national burden and trends of Low back pain in middle-aged adults: analysis of GBD 1990–2021 with projections to 2050

ObjectiveThis study aims to systematically evaluate the burden of low back pain(LBP) in the middle-aged population across global regions and between genders, assess the major risk factors and their impacts, and project the burden to 2050, providing a scientific basis for global preventive actions.MethodsThis study utilized The Global Burden of Disease(GBD) 2021 database. First, we integrated the population data of the 45–49, 50–54, and 55–59 age groups provided by the GBD using a weighted average method to calculate the Disability-adjusted life years(DALYs) rate for the middle-aged population aged 45 to 59 years. Subsequently, we analyzed the trends in the burden of LBP globally and across regions from 1990 to 2021, with a focus on stratified data by country, risk factors (e.g., high BMI), and gender. Finally, we employed the Bayesian Age-Period-Cohort(BAPC) model to predict future trends in LBP burden from 2021 to 2050.ResultsGlobally, from 1990 to 2021, the DALY rate for the 45–59 age group with LBP decreased from 875.45(95%UI: 534.57-1340.68) per 100,000 people to 747.92 (450.55-1,161.66), with an EAPC of -0.46 (95%UI: -0.50 to -0.43). Despite the decline in DALY rates, the total number of DALYs due to LBP increased from 5,515,080.64 (95%UI: 3,367,626.11–8,445,931.67) in 1990 to 9,816,401.64 (95%UI: 5,913,142.33–15,249,187.03) in 2021, a rise of 4,301,321. High Socio-Demographic Index (SDI) regions were the most affected, with a DALY rate of 933.03 (95%UI: 557.90–1,420.60) per 100,000 in 2021. Among risk factors, high BMI showed the most significant increase, with DALY rates rising from 153.64 (95%UI: 15.94–334.63) per 100,000 in 1990 to 209.09 (95%UI: 22.16–452.58) in 2021, and an EAPC of 1.08 (95%UI: 1.02 to 1.14). Gender differences revealed a DALY rate of 705.39 (95%UI: 431.21–1,078.96) per 100,000 for males and 803.62 (95%UI: 471.69–1,266.63) per 100,000 for females in 2021. Projections based on the BAPC model suggest that by 2050, global DALYs due to LBP will increase to 11,626,643.07, with females expected to account for 6,725,763.24 and males for 4,900,879.84, indicating a greater burden for females.ConclusionThis study highlights the global burden and trends of LBP in the middle-aged population. Although the DALY rate for the 45–59 age group decreased from 1990 to 2021, the total number of DALYs increased significantly due to population aging. In this context, the burden of LBP in low-middle SDI regions has remained largely unchanged and remains substantial, while high-SDI regions, despite some decline, continue to bear the highest overall burden. High BMI continues to contribute significantly to the rising LBP burden, particularly in middle-aged populations, and demands urgent attention. Gender differences indicate that females bear a greater LBP burden than males, with the gap widening over time. Effective preventive and intervention measures are urgently needed to mitigate the future burden of LBP.

Growing burden of inflammatory bowel disease in China: Findings from the Global Burden of Diseases 2021 and predictions to 2035.

Inflammatory bowel disease (IBD) imposes a significant economic and social burden in China. We aim to assess the epidemiological trends of IBD in China, and to predict the burden in the near future. The incidence, mortality, prevalence, and disability-adjusted life year (DALYs) of IBD from 1990 to 2021 were obtained from Global Burden of Disease 2021. Estimated annual percentage change (EAPC), average annual percent change, total percent change, and age-period-cohort model were used to access trends. Bayesian age-period-cohort model was utilized to predict the risk of incidence and mortality. In 2021, IBD affected 168,077 people in China, with 24,941 new cases and 5640deaths. The age-standardized rate (ASR) of incidence and death was 1.4 and 0.3, respectively. The incidence and prevalence in China were lower than the global and high socio-demographic index (SDI) regions, but the ASR of incidence and prevalence (EAPC: 2.93 and 2.54, respectively) had rapidly increased from 1990 to 2021. The ASR of death and DALYs had significantly decreased (EAPC: -3.05 and -2.93, respectively). Middle-aged and elderly populations faced a severe burden of incidence and prevalence, while the elderly population faced a severe mortality burden. It is projected that by 2035, the ASR of incidence will continue to rise, whereas the death rate will continue to decline. The burden of IBD in China is serious and increasingly severe. Establishing a comprehensive disease management system in China will help better control the medical burden of IBD.

Changes in Epidemics of Respiratory Viral Infections Resulted From the COVID-19 Pandemic in Shanghai.

To investigate the changing patterns of respiratory viral infections within the context of COVID-19 pandemic. The etiological surveillance data of eight respiratory viral pathogens among patients with ARIs in Shanghai between 2013 and 2023 were analyzed to evaluate the dynamic patterns of respiratory viral infections in Shanghai compared to global other regions during pre-pandemic (period 1), pandemic (period 2), and post-pandemic (period 3) periods of COVID-19. In Shanghai and various other global regions, there was a delay of 2‒4 months in the peak positive rate of IFV and a reverse seasonality for RSV, HMPV, and HBoV was observed following the relaxation of NPIs. The proportion of patients infected with any of these eight viruses experiencing fever or high fever notably increased. During the entire study period, IFV was consistently identified as the most prevalent virus, with IFV-B as the predominant stain during period 2, and IFV-A regained its dominance following the lifting of NPIs. The proportion of RSV among children significantly increased during period 2 compared to period 1. With the relaxation of NPIs, there has been a resurgence of certain viral pathogens, accompanied by notable alterations in seasonal patterns and the spectrum of viral pathogens.

Youth Climate Questions

AbstractAnthropogenic climate change and environmental crises are pressing challenges of our time, with changes to the climate system observed in every global region. Disastrous impacts on nature, including people, have already been observed in the form of drought, floods and extreme heat events across the planet. This study examines the role of an interdisciplinary approach to exploring different responses to climate-related disasters and potential disasters. The work we report takes place in the context of recent research on dialogue on climate interventions with youth. Climate interventions are large-scale interventions into the Earth’s climate system and include proposals such as solar radiation management, ocean liming, and carbon capture and storage technologies. Research and development of climate interventions as a response to one set of disasters (in the present and in-the-making), created as a result of anthropogenic climate change, are associated with much uncertainty and controversy. We explored these uncertainties and controversies with young people, scientists and policymakers, resulting in a set of illustrated climate conversation cards. In this paper, we analyse the questions produced by young people to find requests for data and knowledge from across disciplines, and for an exploration of ethics, feelings, positions and priorities. We also found problematisations of technofixes and desire for socio-political action. The implications for science and disaster education are discussed.

Can mobile promotion automation decrease overall purchases? The role of promotion pattern predictability in customer habit formation

Automating mobile promotions facilitates customization through geo-location and temporal targeting; however, this can lead the geographic and temporal patterns of promotions to become predictable. We argue that this predictability enables customer habit formation as the promotion, the context in which it is received, and the purchase behavior become associated in the customer's memory through repeated co-occurrence. This results in the customer purchasing only when promotions are expected to occur, decreasing their overall purchase likelihood. Across four studies, including empirical data from two different industries in different global regions and two controlled laboratory experiments focused on different purchase scenarios, we find that customers exposed to predictable promotion patterns shift their purchases to when promotions are expected, decreasing overall purchase probability. These effects are stronger for customers with consistent past purchase patterns or low involvement with the product, and predictability of promotion patterns does not impact customer attitudes, providing evidence that they are driven by customer habit formation.

Research trends of collaborative governance in climate change: a bibliometric analysis

Purpose Climate change, a complex global issue, has prompted a wide range of actors – from nations to tiny communities – to seek solutions to mitigate its consequences. The growing emphasis on collaborative governance has resulted in substantial research on the topic. This paper aims to address the existing research void by using a bibliometric approach to investigate the evolution of studies on collaborative governance in the context of climate change. Design/methodology/approach This study conducted a bibliometric mapping of research on collaborative governance on climate change issues from the first study presented in 2007 to the research conducted in 2023, using 222 articles derived from the Scopus database and Web of Science. Steps for comprehensive bibliometric literature mapping via the VOSviewer software. Findings The study includes a complete overview of significant themes, including the most cited research, contributions from authors, countries, and institutions, as well as network analysis including co-citation, bibliographic coupling, and co-occurrence. Notably, the study looks at which countries have made the most substantial contributions, with the United States dominating with 40 studies over the last decade. The analysis reveals that collaborative governance in climate change, emphasizing its importance as a tool for governments and communities to mitigate climate risks. This is consistent with research emphasizing the need for coordination across multiple players to accomplish effective climate adaptation. The paper focuses on nine diverse research clusters, including community engagement, urban governance, disaster response and economic implications. Research limitations/implications This study is restricted to bibliometric analysis, which is conducted using sources from the Scopus and Web of Science databases. Future research is required to investigate the use of additional databases that offer a wider range of sources. In the interim, this investigation provides an overview of the concept of Collaborative Governance, which has the potential to serve as a strategy for the adaptation and resilience to climate change in global regions, cities and urban areas. Originality/value This study conducts a rigorous bibliometric review that improves our theoretical knowledge and practical use of collaborative governance in addressing climate change. It reveals innovative trends, research gaps and important recommendations for future studies, strengthening the strategic approach to collaborative climate action.

Demographic ageing: an opportunity to rethink economy, society and regions

Abstract Ageing is often depicted negatively, but we challenge passive views, suggesting that an “active ageing” agenda requires rethinking economy, urban form and societal responses. We present demographic trends in ageing, migration and urbanization across global regions. Building from psychological theories of ageing regarding disengagement and continuity, we argue for an adjustment response at the societal level to address needed structural changes in economy, social policy and regional planning. These adjustments should prioritize well-being and purpose over economic growth; social policy that links household, informal and formal care and new approaches to urban and regional planning that remake cities for all ages. Ageing requires new paradigms. These societal adjustments will permit new approaches that could build a more inclusive world.

Exploring treatment decision-making at diagnosis for children with advanced cancer in low- and middle-income countries

PurposeGlobal childhood cancer survival outcomes correlate with regional contextual factors, yet upfront treatment decision-making for children with advanced or poor prognosis cancer in low- and middle-income countries (LMICs) is not well understood. This study aimed to (1) characterize the landscape of contextual factors that shape physician decision-making at diagnosis for these children in LMICs and (2) describe physician rationales for if/when to offer treatment with non-curative intent, including how they define “poor prognosis” during treatment decision-making.MethodsAn international panel of pediatric oncologists practicing in LMICs participated in two focus groups structured for the collaborative generation of factors influencing treatment decision-making, including consideration of non-curative treatment pathways at diagnosis. Thematic analysis of qualitative data was conducted, followed by member checking.ResultsEleven pediatric oncologists participated, representing all global regions defined by the World Health Organization. Participants identified a broad range of factors influencing decision-making across multiple levels, including the individual, hospital, health system, community, and country levels. All participants agreed that treatment with non-curative intent could be offered at diagnosis in certain contexts, and diverse definitions for poor prognosis were described.ConclusionsUpfront treatment decision-making for children with advanced or poor prognosis cancer in LMICs is variable and challenging. Difficulties with decision-making in LMICs may be amplified by inconsistent definitions of poor prognosis and underrepresentation of the factors that influence treatment decision-making within existing decision-making frameworks or childhood cancer treatment guidelines. Future research should explore decision-making approaches, preferences, and challenges in depth from the perspectives of pediatric cancer patients, families, and multidisciplinary clinicians.

TRENDS OF GLOBAL REGIONALIZATION IN THE CONSTRUCTION OF THE MODERN SECURITY SPACE

One of the most expected manifestations of globalization has become a noticeable intensification of regionalization trends, which are characterized by the dominance of locally oriented values and priorities. The purpose of the article is the analysis of methodological approaches to the study of the modern stage of the development of globalization transformations in the world, which was called "global regionalization", the representation of conceptual guidelines for its study in the context of modern spatial paradigms, the rethinking of the categories of territoriality and regionalism, tracing the influence of global regionalization trends on the development of modern security strategies. The research hypothesis is focused on defending the priority role of global regionalization in the processes of forming the axial coordinates of the new system of structuring of the global world, creating mechanisms of geopolitical balance and security, determining the main trends and factors of fragmentation of the geopolitical space. It has been proven that the ruptures in regional structures caused by neo-turbulence are accompanied by an intense but not problem-free "superstructure" of the global level over the system of international relations. Significant acceleration of the pace of transformational changes under the influence of military conflicts and confrontations conditions the perception of the world system as a global-regional dynamic object and rethinking of existing theories of security development. The study of the content and forms of territorialization using the methodological tools of global regionalism will make it possible to integrate both theoretical approaches to the understanding of the modern stage of the development of globalization processes, and to actualize regional practices related to the safety of human life in the modern global-regional space.

Incidence, definitions and outcomes of anthracycline induced subclinical and clinical left ventricular dysfunction: a systematic review and meta-analysis

Abstract Purpose To assess incidence and risk factors for anthracycline-induced left ventricular dysfunction, and associated mortality in order to inform patients and providers of the risk, as well as for clinical trial endeavours. Background Anthracyclines (ACs) are very effective cancer therapeutics, but their use is confronted by the risk of cardiotoxicity. Estimates of AC-induced cardiotoxicity based on systematic analyses are limited and have not recently been defined. We present here a systematic review and meta-analysis of the incidence of anthracycline induced subclinical (AC-LVD) and clinical LV dysfunction (AC-CHF) and AC-CHF related mortality in non-liposomal AC recipients over the last 3 decades. Methods We searched Ovid MEDLINE(R), Embase, Cochrane Database and other major databases from their inception until June 22, 2023 for studies examining the rate of AC induced cardiomyopathy in patients receiving ACs and anthraquinones for haematologic, breast (BC) and sarcomatous malignancies. Covidence was used to aid with the management of our systematic review. Screening of abstracts and data extraction was independently performed by 2 reviewers. Results 6,365 abstracts were reviewed, of which 74 were included in the final analysis. 72 studies (n=41,138) reported data on AC-LVD, and 47 studies (n=27,012) reported data on AC-CHF. The average age was 53 years and 50% of the patients were female. Data on cardiac function at baseline was available in only 70% of the studies. Overall, AC-LVD occurred in 8.2% (95% CI 6.8%-10.2% I2 97%) (Fig 1). AC-CHF was noted in 2.2% (95% CI 1.6% to 2.9%, I2 91%) (Fig 2A), mortality related to decompensated AC-CHF was 0.5% (95% CI 0.3%-0.9%, I2 88%) (Fig 2B) while total mortality rate among AC recipients was 24.9% (95% CI 14.8-38.7%, I2 99%). Incidence of AC-LVD was higher in doxorubicin recipients (vs other ACs 10.5% vs 5-5.6%), studies from North America & Asia (vs other regions; 9.3-9.6% vs 6.7%), and prospective studies (vs retrospective studies; 8.7% vs 7.5%). AC-LVD was more common in BC patients (vs other cancers; 8.7% vs 3.5-7.2%) while AC-CHF was more common in lymphoma patients (8.5% vs 1.6-4.1%). AC-LVD was 4.6 times (95% CI 1.2-17.1, p=0.02) more likely in patients with a mean age >70 (vs <70). 21 definitions for AC-LVD were used across the studies. The most common definition (15 studies; n=7904) was "any decline in LVEF from baseline" resulting in a 5.8% rate of AC-LVD. Conclusions AC-LVD and AC-CHF has been reported in up to 10% and 3% of AC recipients, respectively. AC-CHF related mortality occurs in <1% of anthracycline recipients and has a 2-3% share in overall mortality among these patients. The type of malignancy and anthracycline can influence the rate of AC-LVD, AC-CHF and AC-CHF related mortality. Global region, age of the patient population and study design also seem to influence incidence rates. There is noteworthy heterogeneity in definitions for cardiotoxicity across studies.