International Sources Research Articles

Establishment of Evidence-Based Nursing Indices for Dysphagia After Anterior Cervical Spine Surgery.

To select and obtain relevant evidence for the management of dysphagia after anterior cervical spine surgery both domestically and internationally, clinical quality evaluation indicators were developed based on evidence-based nursing practices, and obstacles and promoting factors in evidence-based nursing practices were analysed. This research was aimed to provide a basis for evidence-based nursing practices to promote standardized management of dysphagia after anterior cervical surgery. Dysphagia is the most common complication following anterior cervical surgery, but there is a lack of standard protocols and guidelines to direct clinical practice. Mixed methods were employed for the translational research to support evidence-based practice. This study was based on the JBI evidence-based health care model. According to the '6S Evidence Resource Pyramid Model', we searched from top to bottom. This study is guided by the knowledge to action (KTA) evidence-based practice model. Utilizing a comprehensive evidence-based approach and following the 6S evidence resource pyramid model, relevant evidence on the management of swallowing disorders after cervical anterior surgery was selected from both domestic and international sources. Based on the best available evidence, the Delphi expert consultation method was used to establish a management plan for swallowing disorders post-cervical anterior surgery. Semi-structured interviews were then conducted to identify barriers to clinical implementation, and clinical quality evaluation indicators, as well as promoting factors, were subsequently developed. Based on the 31 best evidence points, 12 evaluation indicators were developed. The baseline results of these indicators reveal that, apart from evaluation indicator 8, which has a compliance rate of 72.2%, the compliance rates for most of the other indicators are relatively low. Based on the results of the clinical quality review, the following main obstacles were analysed: negative behaviours and attributes, lack of professional knowledge, and lack of standardized management. Effective management of swallowing disorders after cervical spine surgery is crucial for enhancing treatment outcomes, reducing complications, shortening hospital stays and improving patient quality of life. This study identified the best evidence for managing dysphagia post-anterior cervical surgery and developed corresponding solutions. The next step involves applying these measures in clinical practice to improve patient prognosis and elevate the quality of care.

Egyptian pediatric kidney transplantation: highlights on post-transplant follow-up and management of complications by the Egyptian Pediatric Clinical Practice Guidelines Committee (EPG) Nephrology Group

BackgroundPediatric kidney transplantation is unique when compared to adults. They need optimum post-transplant care to achieve longer graft and patient survival. Infections, rejection, recurrence, malignancy, bone problems, hypertension, and surgical complications are the most important challenges that require prevention, early detection, and management. Chronic allograft nephropathy needs different approaches based on its related causes, allograft pathology, graft function, and availability of re-transplantation.Aim/objectivesThis national adapted guideline aims to frame evidence-based post-transplant recommendations adopted or adapted from EB source guidelines to optimize post-transplant patient care.MethodsOur guideline is evidence based adapted from four national and international source guidelines with permissions [KDIGO 2020, RA/BTS 2022–2018, EAU 2018] that were appraised with AGREE II instrument tool. We followed the “adapted ADAPTE” CPG formal adaptation methodology that consists of 3 phases and 24 steps and tools. Virtual monthly meetings all through the year 2023 were activated for reviewing and validation of final adaptation of evidence-based guideline draft, considering all comments of external reviewers. This guideline was registered in the practice guideline registration for transparency (PREPARE), number: PREPARE-2023CN364.ResultsRecommendation statements in guidelines stand for results in articles. Discussion of important recommendations and the rationale behind selection of adopted statements and tailoring of others to suit our local facilities, expertise, and renal native disease profile was presented in the text with reasons and references.ConclusionThe provided guidelines aim to improve graft and patient outcome through prevention and early management of complications and suggest research areas lacking validated research recommendations.

Enhancing anti-corruption via investment arbitration: from red flags to due diligence

Abstract As the number of corruption allegations in investor–State disputes (ISDS) grows, tribunals must balance their duty to resolve disputes and to render enforceable awards. Given the difficulty of proving corruption, arbitrators increasingly consider red flags to detect it, but still struggle with drawing consequences for corrupt conduct that would serve as an effective deterrent. Our empirical analysis of 92 ISDS cases that involved allegations of corruption reveals that over a quarter of arbitral decisions already utilize a red flags approach, which helps tribunals assess corruption risks and provide circumstantial evidence. This article proposes a novel list of red flags based on the empirical analysis, domestic and international law sources as well as soft law instruments. It then frames a corresponding anti-corruption due diligence mechanism, which can minimize the risks of corruption occurring, bring more predictability to ISDS and disincentivize frivolous allegations of corruption.

Voices and Perspectives from Our Online Press on the State of English Language Teaching in Mexico

This documentary research on the discourse in electronic media surrounding the teaching and learning of English as a foreign language on the Mexico’s border describes the social framework and analyses various linguistic contexts to make provisional recommendations regarding foreign language policy in Mexico. The digital journalism selected issues an opinion on (1) the teaching of English as a language additional to Spanish in Mexico (English Language Teaching, ELT), and (2) Mexico’s position (at Federal and State level) implicit in their regional implementation of ELT. Thirteen articles from 12 regional, national, and international media sources were analysed using Guespin and Marcellesi’s (1986) and Arnoux and Bein’s (2015) theories, alongside Bardin’s (1996) content analysis method for linguistic contexts in border regions. Qualitative analysis techniques were employed to identify and categorize the positions on foreign language policy presented in the Mexican media. The authors conclude with recommendations for ELT policy, proposing actions for foreign language policy planning. We argue for raised teacher-training standards to improve foreign language learning in mainstream education and Private language schools, thus positioning the Universidad Autónoma de Baja California to take more agency in our regional support role to the Mexican Secretariate of Education

Under the shadow of legality: A shadow hauntology on the legal construction of the Women, Peace and Security agenda

Abstract Considered a landmark in feminist international politics, the Women, Peace and Security (WPS) agenda of the UN Security Council has been the object of many feminist explorations. Feminist legal scholars, however, have grappled with the ‘shadowy’ legality of the agenda, mostly analysing it as an ‘unsuccessful’ legal project: a partial or in progress legal norm, a defective legal form that attests (and furthers) the exile of inclusion of feminists in international law, or yet a formalistic discussion with lesser impact for feminist activists on the ground. Drawing from Avery Gordon’s considerations on taking shadows seriously in our production of knowledge, I propose, however, that reckoning with the shadows of the WPS’s legality enables a more comprehensive analysis of how the agenda has been a successful legal project in its own way. Offering a ‘shadow hauntology’ for the legal status of the WPS, I zoom in on the competing legality perceptions shared by relevant actors, the (gendered and colonially-continuous) shadows that have haunted those perceptions into formation, and how these competing visions have shaped the legality of the WPS as a shadow of its own. This study then offers an alternative way of studying legality both to feminist legal scholarship and studies on international legal sources more broadly. More concretely, it embraces the irresolvability of the legal status of a norm to take stock of the different legal projects and legality perceptions advanced by feminist actors and gender experts, in an effort to understand, in their own terms, the successes achieved.

The current research status of Kansei engineering in the field of emotional clothing design

PurposeThis study provides a comprehensive overview of the research landscape of Kansei engineering (KE) within the domain of emotional clothing design. It explores the pivotal technologies, challenges and potential future directions of KE, offering application methodologies and theoretical underpinnings to support emotional clothing design.Design/methodology/approachThis study briefly introduces KE, outlining its overarching research methodologies and processes. This framework lays the groundwork for advancing research in clothing Kansei. Subsequently, by reviewing literature from both domestic and international sources, this research initially explores the application of KE in the design and evaluation of clothing products as well as the development of intelligent clothing design systems from the vantage point of designers. Second, it investigates the role of KE in the customization of online clothing recommendation systems and the optimization of retail environments, as perceived by consumers. Finally, with the research methodologies of KE as a focal point, this paper discusses the principal challenges and opportunities currently confronting the field of clothing Kansei research.FindingsAt present, studies in the domain of clothing KE have achieved partial progress, but there are still some challenges to be solved in the concept, technical methods and area of application. In the future, multimodal and multisensory user Kansei acquisition, multidimensional product deconstruction, artificial intelligence (AI) enabling KE research and clothing sales environment Kansei design will become new development trends.Originality/valueThis study provides significant directions and concepts in the technology, methods and application types of KE, which is helpful to better apply KE to emotional clothing design.

Regenerative agriculture in Australia: the changing face of farming

The agricultural and social landscape of rural Australia is changing, with many farmers interested in, and some actively moving towards, regenerative agriculture—but what do we understand of the farmers undertaking these transitions? Regenerative agriculture is a holistic way of managing landscapes that aims to move beyond sustainability to regenerate natural systems, while supporting farming system viability. While several authors have discussed the higher-level philosophical underpinnings of regenerative agriculture, there are few empirical studies exploring the motivators for farmers to implement a suite of practices within the regenerative agriculture tool-kit. By undertaking an online survey targeting regenerative farmers, this study identifies common attributes of regenerative farmers, as well as key motivators for, and barriers to change, including perceived benefits arising from the approach. An online survey was promoted through the social media pages of three farming groups, resulting in 96 self-identifying Australian regenerative farmers included in this analysis. Results demonstrate that a clear and recent shift has taken place for this group, who may feel ostracized within their local community, hence often rely on information from online and international sources of agricultural information. This article builds a core understanding of the goals, attributes, aspirations and challenges of regenerative farmers and offers a definition of regenerative agriculture that is derived from farmer responses.

Economic gains from geographic shifts in international sourcing

The geographic evolution of global value chains (GVCs) has been significantly changing the pace and structure of economic development in many countries. We first employ a global input-output (IO) model to quantify the contribution of geographic shifts in international sourcing to China's economic gains. In 2019, China's GDP per capita was 11% below the world average. We show, however, that the gap would have been 39% if there had been no international sourcing shifts between 1995 and 2019. We subsequently propose an optimization model in the global IO framework to explore potential strategies which further improve China's GDP per capita. The optimization results suggest that import substitution and export promotion could be two possible strategies. However, these strategies could fail if all countries adopt the same strategies and participate in the non-cooperative competition. Instead, our results suggest that promoting technological upgrading provides more sustainable opportunities for improving a country's gains.

Chinese expert consensus on blood lipid management in patients with diabetes (2024 edition).

Diabetes is a significant independent risk factor for atherosclerotic cardiovascular disease (ASCVD), with dyslipidemia playing a critical role in the initiation and progression of ASCVD in diabetic patients. In China, the current prevalence of dyslipidemia in diabetes is high, but the control rate remains low. Therefore, to enhance lipid management in patients with diabetes, the Endocrinology and Metabolism Physician Branch of the Chinese Medical Doctor Association, in collaboration with the Experts' Committee of the National Society of Cardiometabolic Medicine, has convened experts to develop a consensus on the management of dyslipidemia in patients with type 1 or type 2 diabetes. The development of this consensus is informed by existing practices in lipid management among Chinese diabetic patients, incorporating contemporary evidence-based findings and guidelines from national and international sources. The consensus encompasses lipid profile characteristics, the current epidemiological status of dyslipidemia, ASCVD risk stratification, and lipid management procedures in diabetic patients. For the first time, both low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol have been recommended as primary targets for lipid intervention in diabetic patients. The consensus also includes a summary and recommendations for lipid management strategies in special diabetic populations, including children and adolescents, individuals aged 75 years and older, patients with chronic kidney disease, metabolic-associated fatty liver disease, and those who are pregnant. This comprehensive consensus aims to improve cardiovascular outcomes in diabetic patients by contributing to the dissemination of key clinical advancements and guiding clinical practice.

The Existence and Development of Variants in English Writing Teaching in International Corpus based on Time Series Data Analysis

This study investigates the evolution and prevalence of variant forms in English writing instruction within an international context, utilizing a time series analysis of corpus data. Recognizing the dynamic nature of language, especially in educational settings, this research aims to identify and analyze the changes in teaching methodologies and language usage over time. By examining a comprehensive corpus compiled from diverse international sources, the study focuses on how English writing instruction has adapted to linguistic variations and evolving pedagogical approaches.The methodology involves a quantitative analysis of corpus data spanning several decades, enabling a longitudinal view of trends in English writing teaching. The corpus includes a wide range of educational materials, academic publications, and teaching resources from different countries, ensuring a global perspective. Time series analysis is employed to track the frequency and context of various teaching practices and linguistic forms, offering insights into their development and dissemination.Key findings reveal a significant shift in teaching strategies, reflecting an increased emphasis on learner-centered approaches and the integration of digital technologies. Variants in language usage, influenced by cultural and regional differences, are also evident, highlighting the importance of context-specific teaching methods.

LEADERSHIP BEHAVIORAL DEVELOPMENT OF MILLENNIAL LEADERS AS A CHANGE AGENT IN THE DIGITAL TRANSFORMATION ORGANIZATION

<p>The digital transformation era and Industry 4.0 provide ample opportunities for this generation to thrive with their rapid technological adaptation and openness to new ideas. This research examines millennial leadership behavioral development to enable them to effectively become change agents in digital organizations, using the case study of William Tanuwijaya at Tokopedia. Through a review of literature from international sources during 2020–2023, this study discusses millennial leadership theories and change management, highlighting the urgency and importance of adaptive leadership capable of managing change in the face of digital organizational challenges. The research findings indicate that millennial leadership styles vary according to organizational contexts. Millennials are confronted with change management, where organizational readiness to adapt is critical to success. Adaptive leadership, a key strategy in managing change, is crucial. Through William Tanuwijaya's leadership at Tokopedia, millennial leadership characteristics prioritizing social and environmental issues, sustainability, and the implementation of sustainable values are evident, alongside collaboration with the government to create an inclusive environment and focus on innovation and digital transformation in the economy. Leaders like William Tanuwijaya start by building teams consisting of celebrities or public figures in Indonesia to promote Tokopedia and strengthen the company's image while formulating the company's vision and initiatives, motivating employees, overcoming obstacles such as improving work efficiency, implementing successful minor changes, ensuring smooth change integration, and making change an integral part of the organizational culture and system.<strong></strong></p>

Transarterial radioembolization vs transarterial chemoembolization with drug-eluting beads for treating hepatocellular carcinoma: a cost-effectiveness analysis in Japanese healthcare system.

Transarterial radioembolization (TARE) is effective for unresectable hepatocellular carcinoma; however, it awaits approval in Japan. This study aimed to simulate the cost-effectiveness of TARE over chemoembolization when TARE is approved in Japan and identify the requirements for cost-effectiveness. A Markov model was constructed to analyze the costs and effectiveness associated with TARE and transarterial chemoembolization with drug-eluting beads (DEB-TACE) for 2-month cycles over 5years. In the primary analysis, the intention-to-treat survival data were used to calculate transition probabilities, whereas the ancillary analysis assessed the per-protocol survival data. DEB-TACE costs were calculated using the Japanese nationwide claims Diagnosis Procedure Combination database between April 2018 and March 2022, whereas TARE costs were estimated using database and international sources. The incremental cost-effectiveness ratio (ICER) was determined based on the payer's perspective and compared with the Japanese willingness-to-pay threshold of 5 million Japanese yen (JPY) (31,250 USD) per quality-adjusted life years (QALY). From the claims database, 6,986 patients with hepatocellular carcinoma who received DEB-TACE were identified. In the primary analysis, the ICER was 5,173,591 JPY (32,334 USD)/QALY, surpassing the Japanese willingness-to-pay threshold. However, the ancillary analysis showed a lower ICER of 4,156,533 JPY (25,978 USD)/QALY, falling below the threshold. The one-way deterministic sensitivity analysis identified progression-free survival associated with TARE and DEB-TACE, DEB-TACE costs, and radioactive microsphere reimbursement price as key ICER influencers. The primary analysis suggested that setting the reimbursement price of radioactive microspheres below 1.399 million JPY (8,744 USD), approximately 2.8% lower than the price in the United Kingdom, would place the ICER below the Japanese willingness-to-pay threshold. Under specific conditions, TARE can be a more cost-effective treatment than DEB-TACE. If the reimbursement price of radioactive microspheres is set approximately 2.8% lower than that in the United Kingdom, TARE could be cost-effective compared with DEB-TACE.

Characterizing HIV-1 transmission by genetic cluster analysis among newly diagnosed patients in the China-Myanmar border region from 2020 to 2023

ABSTRACT Cluster analysis of HIV sequence can provide insights into viral transmission patterns in border regions. This study aims to illuminate the HIV-1 subtype distribution and transmission dynamics among newly diagnosed individuals in Dehong prefecture, a region along the China-Myanmar border. Among 948 participants with pol gene sequences, 36 HIV-1 subtypes were identified, with URFs (18.8%, 178/948) being the dominant strain, followed by CRF01_AE (18.5%, 175/948) and CRF07_BC (10.9%, 103/948). Additionally, 287 sequences (30.3%, 287/948) were grouped into 91 clusters, 31 of which contained both Chinese and Burmese individuals. Multivariable logistic regression indicated that men who have sex with men (MSM), CD4 + cell count of 200∼499 cells/μl, and 500 cells/μl and above, and CRF01_AE were risk factors for entering the network. Through Chord diagram, we found frequent transmission relationships among heterosexual China male group, especially those over 35 years of age. Additionally, the correlation between heterosexual Myanmar female group and heterosexual China male group among cross-risk groups deserved to be emphasized. Furthermore, the network exhibited a growing trend over time, with the largest active transmission cluster identified in Ruili county. In conclusion, the HIV-1 subtype landscape in Dehong has become increasingly complex, and the region has faced risks of transmission from both domestic and international sources. Targeted intervention strategies should be implemented for MSM, heterosexual Chinese middle-aged and elderly men, and heterosexual Burmese young adults to mitigate these risks. These findings provided evidence-based insights for local government to formulate coordinated transnational intervention approaches.

ASPECTS OF SCIENTIFIC RESEARCH IN UNIVERSAL ENVIRONMENTAL TREATIES: LEGAL AND ECONOMIC ANALYSIS

The article emphasises that aspects of international legal cooperation in the field of scientific research have not yet been the subject of a systematic, comprehensive scientific study either in the context of international law doctrine or in relevant publications. The subject of the study is the legal regulation of scientific research in universal international environmental treaties, with the aim of identifying the specific features of such international legal mechanisms. The paper examines the challenges and paradoxes faced by international environmental law in regulating scientific research as a process, as well as in balancing scientific research with the practical needs for appropriate resources. The research uses hermeneutical, prognostic, comparative and systemic analysis of relevant international treaties as components of the modern system of international law. It applies a complex set of methods, including analysis and synthesis, structural and formal-legal methods, as well as scientific deduction and induction approaches. The combination of these methods provides a thorough examination of how international environmental treaties regulate scientific research. The methodology includes a hermeneutic approach to interpret the language and provisions of various environmental treaties, a predictive approach to forecast potential developments and the outcomes of current regulation, a comparative analysis to identify similarities and differences between different treaties, and a systems analysis to understand how these treaties fit into the broader system of international law. Taken together, these methods provide a reliable basis for assessing the current state and future directions of international legal cooperation in environmental research. The main objective of the article is to reveal the unique characteristics and complexities inherent in the international legal mechanisms governing scientific research under environmental treaties. It aims to highlight the current challenges and paradoxes faced by international environmental law in this context. These include the need to address global environmental problems with often limited and unreliable scientific data, the need to respect and encourage scientific research, and the imperative to balance the search for scientific knowledge with the practical needs of natural resources. The results of the study show that environmental conventions reflect several important challenges. One of the main challenges is to address global environmental issues in the face of a lack of reliable scientific information, while respecting scientific research and its results. Another crucial challenge is to maintain a balance between promoting scientific research and meeting the practical resource needs of humanity. The author posits that international environmental law sources represent an enduring endeavour to achieve equilibrium in the formation of convention bodies. This equilibrium strives to reconcile the sovereign interests of participating states with the necessity of maintaining a high level of expertise within relevant commissions and committees. In conclusion, the paper emphasises the necessity for the continuous development and refinement of legal regulation pertaining to scientific research within the field of international environmental law. This is in order to effectively address the dynamic and complex interplay between scientific advancement and environmental sustainability.

The responsiveness of rural poverty to structural and rural transformations in Ethiopia

AbstractThis study investigates the effects of economic opportunities created by structural transformation, such as income from labor employment and income from nonlabor sources, on the incidence, depth, and severity of rural poverty using the 2018/2019 Ethiopian Socioeconomic Survey data. The effects of rural transformations in terms of nonfarm self‐employment and improved farming systems on poverty are also investigated. Ordinary least square, Probit, Instrumental Variable Probit model, and two stage least square estimation methods are used depending on the nature of outcome variables and the Wald test of exogeneity. The findings show that labor income (especially regular salaried income) and nonlabor income (especially remittance from international sources) are crucial in reducing the incidence of rural poverty. Improvements in crop and livestock practices, on the other hand, reduce the incidence as well as depth and severity of rural poverty. The findings suggest that more attention should be given to enhancing the modernization of crop and livestock sectors by expanding access to farm credit and improved extension systems, among other things.

Strategies for Differential Diagnosis and Management of Ichthyosis in Newborns

Congenital ichthyosis represents agroup of heterogeneous inherited skin diseases characterized by generalized keratinization disorder in the form of hyperkeratosis, caused by abnormalities in epidermal differentiation. The neonatal period is crucial for patients with ichthyosis due to the risk of developing complications, comorbidities, and fatal outcomes. Most complications arise from impaired skin barrier function. This article discusses the manifestations of ichthyosis in newborns, describes risks and complications, and suggests strategies for monitoring and treating patients. Purpose of the study: to present contemporary data on differential diagnosis and treatment strategies for newborn patients with congenital ichthyosis. Materials and Methods: review of Russian and international sources dedicated to the etiology, diagnosis, and treatment of ichthyosis was conducted. Results: Differential diagnosis of ichthyosis in the neonatal period is acrucial task, hence the most life-threatening subtypes are considered. The most severe progression with ahigh risk of fatal outcomes is characteristic of Harlequin ichthyosis. Collodion baby presents with less pronounced symptoms, is not afinal diagnosis, and may later develop clinical manifestations typical of ichthyosiform erythroderma, lamellar ichthyosis, or self-resolving congenital ichthyosis. Netherton syndrome is characterized by acombination of congenital ichthyosis with structural abnormalities of the hair shaft and apropensity for atopy. Epidermolytic ichthyosis, accompanied by the formation of blisters and erosions on the skin, requires differential diagnosis not only with other forms of ichthyosis but also with bullous epidermolysis, staphylococcal scalded skin syndrome, and toxic epidermal necrolysis. Every newborn with described manifestations requires support from amultidisciplinary team of specialists and timely therapeutic and diagnostic measures aimed at preventing the development of complications and deterioration of the patient’s condition. Conclusion: An analysis of global literature data and the practical experience of the authors indicate the complexities of differential diagnosis of ichthyosis forms in the neonatal period. To improve skin condition, prevent infectious complications, and correct electrolyte and respiratory disturbances, symptomatic treatment should begin before adefinitive diagnosis is established.

The resurgence of influenza A/H3N2 virus in Australia after the relaxation of COVID-19 restrictions during the 2022 season.

This study retrospectively analyzed the genetic characteristics of influenza A H3N2 (A/H3N2) viruses circulating in New South Wales (NSW), the Australian state with the highest number of influenza cases in 2022, and explored the phylodynamics of A/H3N2 transmission within Australia during this period. Sequencing was performed on 217 archived specimens, and A/H3N2 evolution and spread within Australia were analyzed using phylogenetic and phylodynamic methods. Hemagglutinin genes of all analyzed NSW viruses belonged to subclade 3C.2a1b.2a.2 and clustered together with the 2022 vaccine strain. Complete genome analysis of NSW viruses revealed highly frequent interclade reassortments between subclades 3C.2a1b.2a.2 and 3C.2a1b.1a. The estimated earliest introduction time of the dominant subgroup 3C.2a1b.2a.2a.1 in Australia was February 22, 2022 (95% highest posterior density: December 19, 2021-March 13, 2022), following the easing of Australian travel restrictions, suggesting a possible international source. Phylogeographic analysis revealed that Victoria drove the transmission of A/H3N2 viruses across the country during this season, while NSW did not have a dominant role in viral dissemination to other regions. This study highlights the importance of continuous surveillance and genomic characterization of influenza viruses in the postpandemic era, which can inform public health decision-making and enable early detection of novel strains with pandemic potential.

Performance and trade competitiveness of Indian spices: A Markov Chain Approach

A study was conducted to examine the growth performance and pattern of spice crop export destinations in India. The growth rate, balance of trade and transitional probability matrix were applied to analyse the study by utilizing the past ten years’ data (2013-2022) collected from various national and international sources. The top five exported spices were selected based on their export values in 2021. The findings showed that India secured a huge surplus of ?2118426 lakhs in 2022 with the growth performance of exports (11.66 per cent) and imports (17.65 per cent) in the last ten years. Sri Lanka was the most stable country, with the highest retention capacity (86.12 per cent) for importing pepper. In contrast, China imported cumin and oleoresins (spice oil) with 86.32 and 47.04 per cent, respectively, and Germany imported mint (38.71 per cent) and Bangladesh for turmeric (74.87 per cent) from India. The study recommends that India should formulate a policy with the aim to create favourable trade relations with targeted countries, which would be a fruitful effort for earning foreign exchanges for the nation. Keywords: Export, import, Markov chain, spices, transitional probability matrix. JEL Codes: R11, P45, Q13, Q17.

Болезнь легионеров с неврологическими проявлениями: клинический случай

INTRODUCTION. Legionnaires' disease may be manifested by neurological symptoms along with lung damage. Cerebellar ataxia and dysarthria are rare extrapulmonary manifestations of legionellosis. These symptoms significantly reduce the quality of life of patients. AIM. To analyze the literature data on neurological manifestations of legionellosis and to present a clinical case of Legionnaires' disease manifestation with neurological symptoms. MATERIAL AND METHODS. We performed an analysis of the available literature. Twenty-four Russian and international literature sources (PubMed databases) were evaluated, describing the characteristics and prevalence of neurological manifestations in Legionnaires' disease. We also described the main theories of the pathogenesis of these clinical manifestations. Our clinical case is presented. RESULTS AND DISCUSSION. As of today, few cases of Legionnaires' disease with cerebellar symptoms have been described. Dysarthria and ataxia are the most frequent manifestations of cerebellar dysfunction in legionellosis. Cases where neurologic symptoms persisted after the resolution of pneumonia have been described previously. There are also reports of manifestation of Legionnaires' disease with cerebellar ataxia. The pathophysiology of cerebellar involvement is unknown. There are hypotheses of toxin-mediated and immune-mediated mechanisms. Recent studies have shown that L. pneumophila can activate receptors responsible for enacting the inflammasome pathway. This mechanism promotes cell death that occurs to remove the intracellular pathogen, which may be responsible for central nervous system dysfunction. CASE PRESENTATION. A 48-year-old woman was hospitalized with a suspected stroke. She works in diamond production and is in contact with aerosolized liquids. Four days before hospitalization she complained of a headache, and in the evening before she lost consciousness. Slurred speech, unsteadiness, and inability to walk were noted. At hospitalization, no instrumental evidence of stroke was obtained. Inflammatory markers were elevated. Chest computer tomography showed infiltrative changes. The rapid test for antigenuria (L. pneumophila) was positive, and community-acquired legionellosis was confirmed. Levofloxacin was administrated. After discharge, dysarthria, dysphagia, and instability in the Romberg pose persisted. CONCLUSION. The example of this clinical observation demonstrates that in rare cases Legionnaires' disease can manifest as other diseases, which requires a certain vigilance of doctors of different specialities in order to timely diagnose the disease. KEYWORDS: Legionnaires' disease, legionellosis, community-acquired pneumonia, central nervous system, infectious disease

Клинические особенности и коморбидные нейропсихиатрические состояния у педиатрических пациентов с тикозными расстройствами. Обзор.

INTRODUCTION. Tic disorders are a common neurological pathology among children and adolescents. Tic disorders and comorbid conditions affect patients' socialization, education, and emotional state. Social stigmatization and discrimination caused by tic disorders have an irreparable impact on personality development, making it necessary to raise awareness and understanding of these conditions. AIM. The objective of this study is to analyze the literature on the features of the etiology, diagnosis, and clinical manifestations of tic disorders and comorbid disorders. MATERIAL AND METHODS. An analysis of DSM-5-TR and ICD-11 criteria, as well as 28 international literature sources from the PubMed database, was performed. This analysis provided descriptions of the diagnostic criteria, etiology, and pathogenesis of tic disorders and comorbid disorders. Data on the clinical manifestations of comorbid disorders, differential diagnosis, and main treatment approaches were also presented. RESULTS AND DISCUSSION. The prevalence of tic disorders is about 1% of the population, with 1 in 5 schoolchildren experiencing tics during their development. Currently, the exact causes of tics are unknown; it is assumed that tic disorders is a multifactorial disease involving heredity, environmental factors, and immune-mediated mechanisms. Additionally, dysfunctions in the cortico-striato-thalamo-cortical circuits and neurotransmitter imbalances play significant roles. About 80% of patients with tics have comorbid neuropsychiatric disorders such as attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, autism spectrum disorders, mixed anxiety-depressive disorders, and sleep disturbances, which in some cases present challenges in the differential diagnosis and treatment of these conditions. CONCLUSION. The high degree of comorbidity in tic disorders necessitates a multidisciplinary approach, involving neurologists, psychiatrists, clinical psychologists, and behavioral therapy specialists. This collaboration aims to achieve the maximum therapeutic effect and improve the quality of life for patients. KEYWORDS: tics, chronic tics, Tourette syndrome, Gilles de la Tourette Disorder