Global Regions Research Articles

Integrated sustainability perspective and spillover effects of social, environment and economic pillars: A case study using SEY model

This study examines the integrated sustainability perspective by mapping the spillover effects among sustainable development pillars including social, environment, and economy. To this end, it estimates the sustainability elasticities between a developing country, Iran, and six global regions including 1- North America, 2- Latin America and Caribbean, 3- European Union, 4- Sub-Saharan Africa, 5- Middle East and North Africa (MENA) and 6- East Asia and Pacific. This estimation uses the SEY model, an econometric package involving simultaneous equations systems, Vector Autoregressive models (VAR), and Granger causality within 1971–2019. This research differs from the previous studies by exploring the sustainability spillovers not only spatially but also across various pillars of sustainable development. The results show that the pillars of sustainable development have significant and positive elasticities. This finding accepts the integrated sustainability perspective since the pillars of sustainable development indicate considerable and synergistic effects from both spatial and contextual outlooks. In this way, the findings support globalization, openness, and flow-based governance, consistent with Sustainable Development Goals (SDGs) 16 (Peace, justice and strong institutions) and 17 (Partnerships for the goals). Therefore, policymakers should strengthen the globalization and openness by establishing and promoting international agreements, global organizations, and inclusive frameworks not only in trade, finance, and economy but also in cultural, social, and political affairs.

Clinical and genetic characteristics of 100 consecutive patients with Birt-Hogg-Dubé syndrome in Eastern Chinese region

BackgroundAlthough an increasing number of patients with Birt-Hogg-Dubé syndrome (BHD) are being recognized in China, clinical and genetic characteristics are not well-defined. In addition, revised diagnostic criteria for the Chinese population was proposed in 2023, we aimed to explore their utility in clinical practice at a rare lung disease center.MethodsWe retrospectively analyzed the data of 100 consecutive patients with BHD diagnosed according to the revised Chinese BHD criteria, encountered at the First Affiliated Hospital of University of Science and Technology of China from Jan 2017 to June 2023.ResultsThere were 100 patients (including 63 females) from 65 unrelated families in Eastern China, mostly Anhui Province. The common manifestations were pulmonary cysts (99%), pneumothorax (60%), and skin lesions (77%). Renal cancer and renal angiomyolipoma were detected in 5 patients each. 37% of patients had no family history of BHD. In total, 25 FLCN germline mutations were detected, including 6 novel mutations. In addition to hotspot mutation c.1285delC/dupC (17%), the most common mutations were c.1015 C > T (16%), c.1579_1580insA (14%), and exons 1–3 deletion (11%) in FLCN. Higher risk of pneumothorax was associated with exons 1–3 deletion mutation and c.1177-5_1177-3de1CTC compared to the hotspot mutation c.1285dupC (91% [95% CI: 0.31, 46.82, p = 0.015] and 67% [95% CI: 0.35, 71.9, p = 0.302] vs. 30%, respectively). The average delay in diagnosis was 7.6 years after initial symptoms. Chinese diagnostic criteria were mostly consistent with typical pulmonary presentations with supportive genetic evidence.ConclusionIn the Eastern Chinese region, patients with BHD present most commonly with pulmonary cysts associated with pneumothorax and skin lesions. However, low incidence of renal cancer along with unexpected renal angiomyolipoma was observed. Genotypic spectrum differed from that reported from other global regions, and genotype association of pneumothorax warrants further research. The revised Chinese criteria for BHD seem more appropriate in diagnosing BHD in Chinese patients.

The role of geographical distance in transnational institutional engagement of the Czech diaspora: a comparative study

Engagement with institutions from migrants’ country of origin, both in the destination country and in the country of origin, is distinct transnational behaviour. This study investigates the impact of geographical distance on the institutional engagement of migrants from Czechia in five global regions. We examine how geographic (physical) proximity to Czechia shapes institutional engagement with the country of origin and identify factors beyond distance influencing institutional engagement. We analyzed survey data from Czech emigrants (N = 940) in neighbouring countries, Western and Northern Europe, Southern and Eastern Europe, overseas Anglo-Saxon countries, and other countries. We found that respondents from all more distant regions have higher levels of institutional engagement in the destination country than those from neighbouring countries. Length of stay and education were relevant factors for all selected regions, while place of residence (living in a metropolis) and the level of transnational behavior had varying impacts across regions. Concerning institutional engagement in origin country, the level of transnationalism was consistently the strongest predictor across. Transnational studies should incorporate geographic variables, such as physical distance into their conceptual frameworks. We expect our findings to be generalizable to other countries similar to Czechia, i.e. high-income countries whose citizens benefit from liberal visa regimes.

Observation-constrained projections reveal longer-than-expected dry spells

Climate models indicate that dry extremes will be exacerbated in many regions of the world1,2. However, confidence in the magnitude and timing of these projected changes remains low3,4, leaving societies largely unprepared5,6. Here we show that constraining model projections with observations using a newly proposed emergent constraint (EC) reduces the uncertainty in predictions of a core drought indicator, the longest annual dry spell (LAD), by 10–26% globally. Our EC-corrected projections reveal that the increase in LAD will be 42–44% greater, on average, than ‘mid-range’ or ‘high-end’ future forcing scenarios currently indicate. These results imply that by the end of this century, the global mean land-only LAD could be 10 days longer than currently expected. Using two generations of climate models, we further uncover global regions for which historical LAD biases affect the magnitude of projected LAD increases, and we explore the role of land–atmosphere feedbacks therein. Our findings reveal regions with potentially higher- and earlier-than-expected drought risks for societies and ecosystems, and they point to possible mechanisms underlying the biases in the current generation of climate models.

Decarceration in Southern Europe: Notes on Climate Change in the Penal Field

AbstractAgainst the backdrop of the economic and political crises affecting Europe in the late 2000s and early 2010s, incarceration rates began to shrink in many European countries, ushering in a decarceration period that continues to this day—albeit with cross-border divergences. In fact, Europe was the world region with the greatest decline in incarceration rates in the 2010s. Evidently, this unexpected shift stands in stark contrast to the penal populism policies characterising penality in global north regions in the 1990s and 2000s, as well as to the mass incarceration path still followed by many global south jurisdictions in the 2020s. Spain is a suitable national case to examine this recent turn, since Spanish incarceration rates increased almost eightfold in just three decades, before an intriguing and steady decline began that is almost unparalleled in western Europe. This paper focuses on the Spanish case, exploring the background and proximate causes that have enabled the current decarceration scenario. In addition, it scrutinises if and to what extent the changes witnessed in the Spanish case reverberate across wider European regions. In so doing, the paper attempts to grasp the climate change impacting the penal field in many global north jurisdictions.

Accurate identification of salt domes using deep learning techniques: Transformers, generative artificial intelligence and liquid state machines

AbstractAcross various global regions abundant in oil and natural gas reserves, the presence of substantial sub‐surface salt deposits holds significant relevance. Accurate identification of salt domes becomes crucial for enterprises engaged in oil and gas exploration. Our research introduces a precise method for the automatic detection of salt domes, leveraging advanced deep learning architectures such as U‐net, transformers, artificial intelligence generative models and liquid state machines. In comparison with state‐of‐the‐art techniques, our model demonstrates superior performance, achieving a stable and validated intersection over the union metric, indicating high accuracy and robustness. Furthermore, the Dice similarity coefficient attaining underscores the model's proficiency in closely aligning with ground truth across diverse scenarios. This evaluation, conducted on 1000 seismic images, reveals that our proposed architecture is not only comparable but often surpasses existing segmentation models in effectiveness and reliability.

A 10-point preoperative checklist: selecting patients for outpatient joint replacement surgery

BackgroundWith advancements in perioperative care, joint replacement (JR) surgery is undergoing a transition from opacified in-patient institutions to nimble out-patient Ambulatory Surgical Centers (ASC). The goal of JR in ASC setting is safe patient discharge with subsequent rehabilitation without readmission. Multi-modal preoperative rehabilitation (MMPR) is a novel field of perioperative care, encompassing comprehensive parameters to ensure smooth transition from fitness for surgery to JR in outpatient setting. At present, there are no open-access schemes for selecting patients qualified for JR in the ASC setting. In this article, we propose an evidence-based, 10-point systematic evaluation of patients with target endpoints for MMPR to qualify patients for JR as an outpatient procedure. This checklist is a non-proprietary scheme serving as an initial framework for surgeons exploring surgery in the ASC setting.BodyWe introduce factors for a prehabilitation scheme, called Checklist Outpatient-Joint Replacement (CO-JR) to qualify patients for outpatient JR surgery. These factors have been developed based on an extensive literature review and the significant experience of authors to incorporate variables that drive a successful outpatient JR procedure. The factors include patient education, psychiatric & cognitive ability, medical fitness, musculoskeletal capability, financial ability, transportation access, patient motivation, information technology (IT) capabilities, along with ability to recover independently at home postoperatively. The CO-JR scheme is under the process of validation at multiple institutions. We introduce this as a starting point for collaborative development of an open-access scheme for all surgeons to learn and adapt as needed for their respective global region.ConclusionWe established a non-proprietary 10-point CO-JR scheme, serving as a framework for surgeons to successfully select patients for JR surgery in the ASC setting. We encourage concomitant validation of this scheme globally. Our goal is to reach an international consensus on an open-access scheme, available for all surgeons to enrol patients for JR in the ASC setting, but modifiable to accommodate regional needs.

More Than Surface Finds: Nubian Levallois Core Metric Variability and Site Distribution Across Africa and Southwest Asia

Nubian Levallois cores are currently one of the most debated artefact types in Palaeolithic archaeology. Previous work has focused mainly on the definition and technological characteristics of these cores, with discussion of their distribution framed only in qualitative terms. Here, we present the first quantitative spatial analysis of sites with Nubian Levallois cores across the five global regions where they occur. Using modelled Pleistocene conditions for various bioclimatic and topographic variables, we compare the environmental context of 84 sites featuring Nubian cores with 81 contemporaneous sites where they are absent. Metric analysis of cores from 14 new and previously published sites offers further insights into technological and behavioural patterns at an inter-regional scale. Our results show that Nubian cores during MIS 5 are present in areas characterised by aridity, complex topography, and high biomass, whereas for MIS 3, only temperature was a significant predictor. Metric results reveal distinct patterns in both space and time, finding the largest and most standardised cores in Southern Arabia during MIS 5, with the smallest cores in MIS 3 Eastern and Southern Africa. We propose that environmental factors were a more significant driver behind the adoption of the Nubian Levallois method than previously acknowledged. Our results provide essential environmental context for future model-testing of Late Pleistocene demography and cultural connectivity during this critical phase of human evolution.

Melanoma Incidence and Mortality Trends in Sweden.

Over the past decades, many global regions have experienced a steady increase in the incidence of cutaneous melanoma. However, more recently, a downward trend has been observed in the younger age groups in Australia and the US. Yet, in Europe, none of the countries have reported any significant decline in melanoma incidence for any age group. To assess melanoma incidence and mortality trends in Sweden, with a focus on individuals younger than the average age of melanoma onset. This cohort study used data on the national population from the Swedish Melanoma Registry and the Swedish Cancer Registry, which cover more than 99% of all primary invasive cutaneous melanomas diagnosed in the country. All patients diagnosed from 1990 to 2022 were included. Incidence and mortality rates per 100 000 inhabitants were calculated for each year and shown as average annual rates for every 5-year period from 1990 to 2022. Joinpoint regression models were used to evaluate statistical significance of temporal trends and points of change. There were 34 800 primary invasive cutaneous melanomas (19 582 [56.3%] in females and 15 218 [43.7%] in males) reported in 33 324 individuals younger than 60 years (median [IQR] age, 48 [36-58] years) from 1990 to 2022. A consistent rise in melanoma incidence was observed among those 50 to 59 years old. The age groups from 20 to 29 years, 30 to 39 years, and 40 to 49 years showed an incidence peak in 2013 to 2015 followed by stable or significantly declining rates until 2022. In patients younger than 20 years, melanoma incidence remained low with no significant trends. There was also a significant decline in melanoma mortality among 30- to 59-year-old individuals, but not in those 60 years and older. The findings of this cohort study showed a significant recent downward trend in both melanoma incidence and melanoma mortality in the age group 30 to 49 years in Sweden. The reasons for these declines are unclear but may include UV protection, public health campaigns, changing population demographics, and the introduction of effective melanoma treatment. None of these possibilities were evaluated; further study is needed.

PRP, Exosomes, and Stem Cells: An International Perspective

ABSTRACTBackgroundRegenerative medicine is a novel, developing field centered on efforts to repurpose the body's own molecular makeup to target specific problems. Specifically, the use of stem cells, platelet‐rich plasma, and exosomes is rapidly expanding. Internationally, there remain different guidelines and a variety of medical uses, encouraging an exploration into the medical and cosmetic benefits offered.AimsThis study aims to investigate current literature on the international perspectives of PRP, stem cells, and exosomes to present a global review on how these are obtained and utilized.MethodsA literature search was conducted on PubMed reviewing PRP, exosomes, and stem cells, among other related topics, and their applications in medical, pharmacologic, and dermatologic fields. Research produced by various global regions was examined to identify similarities and differences.ResultsStem cells have been successfully implemented in the oncology and dermatology realms as a result of their plasticity and ability to quickly replicate and divide. Platelet‐rich plasma is of strong interest due to platelets' extracellular vesicles and their unmatched abilities. Exosomes are actively being studied in the fields of neurology and rheumatology, among others. International guidelines are reviewed based on regulations of these materials. Potential ethical barriers of isolation and source utilization are explored.ConclusionsThe perspectives and findings considered here stress the potential expanding uses of PRP, stem cells, and exosomes on a global scale. We highlight the need for further clinical studies and international collaboration among varying guidelines to best utilize these tools in the field of dermatology and medicine.

Does the distribution of Wormian bone frequencies across different world regions reflect genetic affinity between populations?

BackgroundWormian, or sutural bones, are additional, irregularly shaped bone fragments that can occur within cranial sutures. These bones may arise due to various factors, including mechanical pressure on skull bones during early ontogenetic stages, such as during artificial cranial deformations, or due to genetic and environmental influences. This study investigates the potential genetic basis of sutural bones by comparing their frequencies across diverse global regions. It analyzed 33 craniological series, encompassing 2059 crania, to assess the frequency of sutural bones in the coronal, squamous, lambdoid, and occipitomastoid sutures among skeletal populations from regions including Aboriginal Australia, Melanesia, Southeast Asia, Siberia, Europe, and Native America. Biological distances between populations were calculated using Smith’s mean measure of divergence (MMD), with results visualized through multidimensional scaling.ResultsThe analysis identified distinct clusters of Caucasian and Siberian populations. Siberian aboriginal populations are compactly grouped, consistent with mtDNA data indicating genetic roots dating back to the Neolithic inhabitants of the Lake Baikal region. Further, differentiation within these populations is linked to the founder effect and gene flow. Notably, genetically related groups like the Inuit and Chukchi of Chukotka differ from other Siberian groups. In contrast, southern Siberian populations, such as the Buryats and Mongols, are closely positioned, aligning with genetic data. The differentiation between Southeast Asian and African regions was subtler, with their clusters largely overlapping. Yet, genetic links between populations were observed in some cases. Thus, Australians, Melanesians, and Papua New Guineans were located close to each other on the multidimensional scaling map, as were two African populations.ConclusionsThe findings tentatively suggest a potential genetic component in the expression of Wormian bones, although this hypothesis requires further empirical support, particularly through genetic studies. While genetic factors may influence the expression of Wormian bones, environmental conditions and pathological processes also play significant roles. It can be suggested that Wormian bones could potentially serve as an additional tool in kinship analysis within burials; however, their utility significantly depends on the extent of their genetic influence. If future genetic studies confirm a substantial genetic component and its dominance over environmental factors, the use of these bones in anthropological and forensic analyses would receive additional validation.

Climate change induced heat and drought stress hamper climate change mitigation in German cereal production

ContextAgricultural production and climate change strongly influence each other and there are significant efforts to minimize negative impacts in both directions. In particular, breeding progress has succeeded in reducing the carbon footprint (CFP) of cereals over time. However, there is widespread certainty that climate change-related weather extremes have led to stagnation of cereal yields in many global production regions. Research questionWe assume that climate change-related yield stagnation is also evident in variety trials in Germany, which has to date only been shown for on-farm yields. Furthermore, we expect that the stagnation in yields also leads to a stagnation in the downward trend of CFP, and that heat and drought stress in particular increase the CFP of cereals. In addition, we hypothesize that the site-specific soil quality largely determines stress induced increases in CFP. MethodsWe conduct a partial life cycle assessment (LCA) with German variety trial data from 1993 to 2021 and determine the greenhouse gas emissions per unit of land (GHGL), as well as the CFP of winter wheat, winter rye, and winter barley. Further, we evaluate the time trends of yield, GHGL, and CFP using linear and quadratic plateau models. In addition, we calculate spatio-dynamic weather indices (WIs) for moderate, severe and extreme heat and drought stress. Using mixed models, we estimate the explanatory power and effect size of heat and drought WIs on the CFP. Finally, we present the spatial differences of heat and drought on the CFP at different soil qualities. ResultsWe show yield plateaus in all crops and stagnating GHGL trends, resulting in a stagnation of the downward trend of CFP, especially for rye and barley. We highlight that heat and drought increase the CFP of all crops. However, the impact of heat and drought on the CFP varies greatly with soil quality across all crops. ConclusionsWe conclude that climate change-induced weather extremes are major challenges not only for cereal production and food security but also for climate change mitigation in the agricultural sector, highlighting the importance of high-yield locations, alongside variety selection and resource-efficient management, for climate change mitigation. SignificanceThis study is the first that proves significant yield stagnation in German variety trials. Moreover, this study is the first to analyze the impact of heat and drought stress on cereal CFP, with novel results that proof that climate adaptation will become a crucial aspect of climate change mitigation in field crops.

An Optimized Semi-Supervised Generative Adversarial Network Rice Extraction Method Based on Time-Series Sentinel Images

In response to the limitations of meteorological conditions in global rice growing areas and the high cost of annotating samples, this paper combines the Vertical-Vertical (VV) polarization and Vertical-Horizontal (VH) polarization backscatter features extracted from Sentinel-1 synthetic aperture radar (SAR) images and the NDVI, NDWI, and NDSI spectral index features extracted from Sentinel-2 multispectral images. By leveraging the advantages of an optimized Semi-Supervised Generative Adversarial Network (optimized SSGAN) in combining supervised learning and semi-supervised learning, rice extraction can be achieved with fewer annotated image samples. Within the optimized SSGAN framework, we introduce a focal-adversarial loss function to enhance the learning process for challenging samples; the generator module employs the Deeplabv3+ architecture, utilizing a Wide-ResNet network as its backbone while incorporating dropout layers and dilated convolutions to improve the receptive field and operational efficiency. Experimental results indicate that the optimized SSGAN, particularly when utilizing a 3/4 labeled sample ratio, significantly improves rice extraction accuracy, leading to a 5.39% increase in Mean Intersection over Union (MIoU) and a 2.05% increase in Overall Accuracy (OA) compared to the highest accuracy achieved before optimization. Moreover, the integration of SAR and multispectral data results in an OA of 93.29% and an MIoU of 82.10%, surpassing the performance of single-source data. These findings provide valuable insights for the extraction of rice information in global rice-growing regions.

737. ETHNIC, GENDER AND TUMOR-SPECIFIC ASSESSMENT OF BODY COMPOSITION IS CRITICAL FOR CLINICAL RELEVANCE IN PATIENTS UNDERGOING THERAPY FOR ESOPHAGEAL

Abstract Background Growing evidence has supported a role for body composition in predicting survival in patients undergoing esophagectomy. A contemporary meta-analysis of published data (n=44 studies) conducted for this study confirmed an association between reduced muscle mass at diagnosis and worse overall survival (HR 1.72, 95%CI 1.49-1.97). Variation in methods of assessing and defining parameters of body composition remain however an important barrier to the wider adoption in routine clinical practice. This is particularly pertinent in esophageal cancer due to known sex, biological and geographical difference in tumor subtypes. This study seeks to define baseline variation in body composition parameters and to report their association with 90-day and overall survival in a large international cohort of patients undergoing esophagectomy for cancer. Methods Patients who underwent esophagectomy in fourteen high-volume centers between January 2007 to December 2019 were eligible for inclusion. Survival data were included up until June 2022. Skeletal muscle, visceral and subcutaneous adipose tissues within CT images, acquired at the time of diagnosis, were analyzed in accordance with a standardized protocol. Results 1716 patients were recruited to this study from three global regions: North America (n=386;22.5%), Europe (n=940;54.8%) and Asia (n=390;22.7%). Patients were predominantly male (79.5%) and adenocarcinoma was the most common histological subtype (66.6%). Wide variation of skeletal muscle (17.1-83.5cm2), visceral adiposity (0.2-170.1cm2) and subcutaneous adiposity (0.2-216.8cm2) was observed at presentation. Characteristics significantly associated with levels of muscle and adiposity were global region, sex, age, and histological subtype (P<0.001) (Figure 1). Compared to adenocarcinoma, squamous cell carcinoma was associated with significantly lower levels of muscle and adiposity, a finding that was independent of global region, sex, and age using a multivariable linear regression model (p<.0001). Median follow-up was 71.3 (95%CI 69.1-73.5) months with a median overall survival of 60.9 (95%CI 53.0-68.9) months. Reduced skeletal muscle and an excess of total adiposity at the time of diagnosis was associated with worse 90-day mortality and long-term survival. An interactive online survival prediction tool was developed to provide personalized survival estimates based on relevant predictors including skeletal muscle, total adiposity at diagnosis and other tumor and patient specific variables. Conclusions This is the first and largest study to adopt standardized methods to define international variation in parameters of body composition in esophageal cancer patients. Findings corroborate the potential role of body composition as a method of prognostication in esophageal cancer and presents a on-line tool for convenient integration into clinical practice.

On the circular entrepreneurship across continents: An analysis of terms of business descriptors

AbstractThis study analyzes circular entrepreneurship trends across global regions using the 2014–2018 Global Entrepreneurship Monitor dataset. Content analysis of business descriptors from 79,663 unique entrepreneurs was used to position each startup within the 9R's framework. The results show that startups are mainly associated with “repurpose” and “recover”, which are less desirable for circularity. We further define circular entrepreneurs as those with the top 10% highest weighted score in circular strategies according to the type of business they run. The BERTopic approach is applied to identify specific business topics for these entrepreneurs. Similarities (North America and Latin America & the Caribbean) and differences (Europe) in popular topics are found across regions. Lastly, regression analysis reveals that entrepreneurial perception and the presence of role models are key factors driving circular entrepreneurship.

Evaluating implementation of a hospital-based cancer registry to improve childhood cancer care in low- and middle-income countries.

Cancer is a leading cause of global childhood mortality, affecting 400,000 children annually. While treatable with modern therapies, children living in low- and middle-income countries (LMICs) have limited access to care and lower survival rates. Hospital-based cancer registries (HBCRs) collect detailed patient information to critically evaluate and evolve care. The St. Jude Global Childhood Cancer Analytics Resource and Epidemiological Surveillance System (SJCARES) is a cloud-based HBCR network facilitating quality data collection of pediatric cancer. Wide variation in the success of implementation has warranted further research into the implementation approach, to create a sustainable and adaptable HBCR in LMICs. Seven of 89 sites using the SJCARES registry were selected, stratified by global region and stage of implementation. Semi-structured interviews were conducted with key groups (clinicians, administrators, data clerks) using an interview guide developed from the Consolidation Framework for Implementation Research (CFIR). Interviews were conducted via a video-telephone software program and transcribed by a transcription service. Transcripts were thematically coded using rapid qualitative analysis. A total of 18 participants (11 clinicians, 4 administrators, 3 data clerks) were interviewed. Several barrier themes were identified, including: difficulty integrating the registry into existing workflow; lack of resources; lack of government or administrative support; and damaged, misplaced, or illegible medical records. Facilitator themes were identified, including: internal support for the registry; clear and extensive training; and dedicated support staff. Interviewed participants identified key barriers and facilitators to the implementation of the SJCARES registry across multiple phases. We plan to use these results to develop targeted implementation strategies including a readiness assessment tool to help guide more successful implementation of the SJCARES registry and other HBCRs in LMICs.

Probing the D-region ionosphere globally with Earth Networks Total Lightning Network data

An existing technique to use broadband lightning waveforms to probe the D-region ionosphere (60–90 km altitude) is shown to be extendable to a global scale using the Earth Networks Total Lightning Network (ENTLN). This paper demonstrates the technique in detail on a region of the Southeastern United States. This demonstration shows that diurnal D-region height variation and smaller time-scale variations on the order of tens of minutes to hours are evident in the measurement. The technique is then extended to three additional global regions on this same day: Northeastern U.S., India, and Japan. The diurnal behavior between these different regions is compared to a D-region model from the International Reference Ionosphere.

Assessing Radiology and Radiation Therapy Needs for Cancer Care in Low-and-Middle-Income Countries: Insight From a Global Survey of Departmental and Institutional Leaders

BackgroundThe global cancer burden and mortality rates are increasing, with significant disparities in access to care in low-and-middle-income countries (LMICs). This study aims to identify radiology and radiotherapy needs in LMICs from the perspective of departmental and institutional leaders. MethodsA survey was developed and conducted by the American Association of Physicists in Medicine (AAPM) Global Needs Assessment Committee (GNAC) and the AAPM International Council. The survey, organized into five sections (Introduction, Infrastructure Needs, Education Needs, Research Needs, and General Information), was open to respondents from March 1 to August 16, 2022. FindingsA total of 175 responses were received from six global regions: Africa (31.4%), Americas (17.7%), Eastern Mediterranean (14.3%), Europe (9.1%), South-East Asia (23.4%) and Western Pacific (4.0%). The greatest reported need was for new or updated equipment, particularly PET/CT imaging technology. There was also a high demand for clinical and equipment training. Approximately 25% of institutions reported a lack of radiology-based cancer screening programs due to high healthcare costs and a shortage of specialized equipment. Many institutions that expressed interest in research face funding and grant challenges. InterpretationThe findings highlight critical areas where organizations can support LMICs in enhancing radiology and radiotherapy services to mitigate the growing cancer burden.

Age-period-cohort analysis of global, regional, and national pancreatic cancer incidence, mortality, and disability-adjusted life years, 1990–2019

BackgroundPancreatic cancer is one of the deadliest cancers in the world. In recent years, the incidence and mortality rates of pancreatic cancer have shown an increasing trend year by year. This study investigates the independent effects of age, period, and cohort on the global incidence, mortality, and disability-adjusted life years (DALYs) of pancreatic cancer from 1990 to 2019, and evaluates the differences in the burden of pancreatic cancer across regions with different Sociodemographic Index (SDI) levels.MethodsEstimating the impact of age, period, and cohort on pancreatic cancer disease burden in different SDI regions using age-period-cohort modeling with data (with 95% uncertainty intervals [UI]) from the Global Burden of Disease (GBD) Study 2019 and net drift of age-standardized incidence rates (ASIR), age-standardized mortality rates (ASMR), and age-standardized DALY rates (ASDR) for pancreatic cancer in 120 countries.ResultsThe number of new cases of pancreatic cancer worldwide increased from 197,348 (95% UI: 188,604,203,971) in 1990 to 530,297 (486,175,573,635) in 2019, the number of deaths increased from 198,051 (189,329 to 204,763) in 1990 to 531,107 (491,948 to 566,537) in 2019, and the number of DALY increased from 4,647,207 (4,465,440 to 4,812,129) in 1990 to 11,549,016 (10,777,405 to 1,238,912) in 2019. The ASIR of the average levels in global pancreatic cancer increased from 5.22 (4.97 to 5.40) per 100,000 population to 6.57 (6.00 to 7.09) per 100,000 population, the ASMR increased from 5.34 (5.07 to 5.52) per 100,000 population to 6.62 (6.11 to 7.06) per 100,000 population, and the ASDR increased from 115.47 (110.82 to 119.60) per 100,000 population to 139.61 (130.18 to 149.14) per 100,000 population. The incidence, mortality, and DALY rates of pancreatic cancer increase with age globally and across all SDI regions, peaking in the 85–89 age group. In high and high-middle SDI regions, the growth rate for males is higher than for females before the age of 85, while females have a higher growth rate after 85. The 75–79 age group exhibits the highest DALY rate in high and high-middle SDI regions, significantly higher than the global and other SDI regions. From 1990 to 2019, the period effects of pancreatic cancer incidence, mortality, and DALY rates have increased significantly worldwide, while remaining almost unchanged in high and high-middle SDI regions. In contrast, period effects have significantly increased in middle, low-middle, and low SDI regions. Cohort effects are more pronounced in middle, low-middle, and low SDI regions.ConclusionsWith the aggravation of population aging, the incidence and mortality rates of pancreatic cancer in the world are increasing, and effective prevention and control measures can be achieved by reducing the exposure of risk factors. The APC model used in our analysis provides a novel approach to understanding the complex trends in the incidence, mortality, and disability-adjusted life years of pancreatic cancer. It can inform the development of targeted interventions to reduce the severe disease burden caused by pancreatic cancer.

DFMC SBAS service performance analysis of multi-GNSS based on BDS-3 in different regions

Abstract The dual-frequency multi-constellation satellite-based augmentation system (DFMC SBAS) plays a crucial role in many fields, such as civil aviation and other safety-critical applications. To analyze the performance of the third generation of the BeiDou navigation satellite system (BDS-3) dual-frequency SBAS services in global major regions and the enhancement of navigation service performance by multi-Global Navigation Satellite System DFMC SBAS, four schemes are designed to conduct experiments using user end positioning in China (CHN), Europe (EUR), and Australia (AUS), and the results are analyzed under Approach with Vertical guidance I (APV-I) and Category I Precision Approach (CAT-I). In terms of the number of enhanced satellites, user range error, positioning accuracy, and DFMC SBAS service integrity, the results show that the positioning performances of the BDS-3 DFMC SBAS in the horizontal and vertical directions are 0.60 and 1.12 m for the CHN region, 0.87 and 1.39 m for the EUR region, and 0.64 and 1.11 m for the AUS region. In the CHN and AUS regions, the horizontal and vertical accuracies are comparable and better than those in the EUR region. Under the APV-I performance index, except for stations at the edge of the service range in the CHN and AUS regions, the availability and continuity of all stations were 100% and over 99% in the EUR region. The BDS-3 + Galileo + GPS DFMC SBAS service can significantly improve the positioning accuracy compared to a single constellation. Under the APV-I performance index, the availability and continuity of all stations in the three regions reached 100%, which also satisfied the minimum requirement of CAT-I service availability (99%).