Number Of Crises Research Articles

Volatility spillovers and time-varying correlations across stock and commodity markets: An assessment during the epidemic crisis era

The financial and economic stability of the business world is greatly damaged by a number of crises over the years. These crises also change and affect stock markets around the globe. This study examines the nonlinear behavior of well-known stock markets in the US, Europe, Canada, and Asia (S&P 500, Nikkei 225, CAC40, DAX30, Bombay Stock Index, Hang Seng Index, and Canadian Stock Index). We also investigate the commodity indexes (Gold, Bitcoin, Brent Crude Oil, and West Texas Crude Oil). The transmission of returns and the volatility propagation pattern across stock-commodity markets during the COVID-19 era is analyzed using the VAR DCC MEGARCH model. The results demonstrate that correlations intensify and become more complicated during the COVID-19 period, especially between financial market indices and oil commodity indices. However, the volatility spillover statistics during the pandemic period show a definite rise in the uncertainty of financial market indices due to index instability. The analysis also shows that financial markets experience a substantial leverage effect during the pandemic crisis. According to the research, Bitcoin is crucial for reducing portfolio risk during the health crisis, and gold proves to be the best option for investors to diversify their financial risk.

Uncovering the (Possible) Relationship between Central Bank Independence and Economic Growth in the Context of Monetary Unions

Abstract This work estimates the relationship between Central Bank Independence (CBI) and economic growth in the context of monetary unions, using dynamic panel models. We use two measures of CBI: the Legal CBI index and the irregular turnover rate. When an irregular turnover of the Central Bank Governor occurs, it harms growth for countries outside monetary unions. On the contrary, the Legal CBI index is a positive factor for growth, although only regarding countries belonging to monetary unions. The limitations on lending to the government is the most important component of the Legal CBI, which explains this result. Additionally, we analyse sub-samples taking into account the level of income, the number of crises, the existence of quantitative easing policies, and different time windows. Interestingly, 1990–2013 was a harmful period for growth for the entire sample but benign for countries that belong to monetary unions. Moreover, when countries are in a crisis they benefit from being a member of a monetary union with an independent central bank. Results seem to point to the conclusion that Legal CBI in a monetary union has the potential to increase economic growth rates. (JEL codes: C23, E58, and O43)

E-commerce Development Under the Epidemic

Due to COVID-19's effects, China's market economy is currently dealing with a number of crises and difficulties. People were compelled to separate at home, the network shopping trend has emerged in place of offline consumption, e-commerce platforms in this time period have a unique allure, many businesses take advantage of opportunities to grow their electrical businesses, and in light of the results of the economic market analysis, it is concluded that the majority of people's consumption demand is based on the demand for items on electric business platforms, which has expanded and enriched the electrification of society. In order to prevent potential issues with the transaction, ensure the safety of express transit, strengthen the pertinent rules and regulations, and identify appropriate solutions for the current issues.

Мистецтво лікування в епоху постмодерну

The article deals with the peculiarities of the development of the mankind, medicine, the art of healing in different periods (pre-industrial, industrial, post-industrial) of the pre-modern, modern, postmodern epochs. Particular attention is paid to the postmodern period the appearance of which is connected with the disturbance of a human to adapt to the extraordinary acceleration of the pace of scientific development as well as development of technology, biomedical technologies, the increase in the number of crises and catastrophes. The features of the postmodern period in which the mankind is are under consideration: dehumanization of society, culture, medicine; identity crisis of an individual, patient, doctor; transformation of medicine into a service sector; a gap between the achievements of the life sciences, modern biotechnologies and a disappearing art of healing. The problems of the post-COVID world, the nearest future of the mankind are discussed.

Relationship Between Emergencies and Child Mental Health

The world we live in is affected by increasing emergencies and disasters. The increase in the number of crises is significantly affected by climate change, which is also one of the significant problems of today. Earthquakes, droughts, floods, snowfall, hail, storms and fires are natural emergencies. They can also be technical-technological or caused by the consequences of the war. Regardless of the cause, emergencies disrupt social and material goods. Therefore, it is necessary to better prepare for crisis situations to preserve human life and reduce harmful consequences. Emergencies cause many consequences for the mental health of people, especially children. A child in any crisis needs acceptance, understanding and support; thus, mental health care is crucial because it ensures adequate growth and development and has positive effects on their lives and the life of society. Mental health promotion should be carried out from an early age because regular care for mental hygiene makes it easier to cope with difficulties throughout life, prepare for crisis events and faster recovery. This paper aims to examine the impact of emergencies on children’s mental health, i.e., to present a review of domestic and international professional literature that promotes the importance of preserving children’s mental health in specific situations such as emergencies in Croatia and worldwide

Job loss, financial strain, and housing problems as suicide precipitants: Associations with other life stressors

Previous research has shown that job loss, financial strain, and/or loss of housing (JFH) in midlife elevate suicide risk. In this study based on the 2017–2019 National Violent Death Reporting System, we examined other suicide precipitants and contributors of decedents whose suicide was in part precipitated by JFH and the circumstances under which they died. First, we examined all adult decedents (N = 94,454; 74,042 males [78.4%] and 20,412 females [21.6%]) and then focused on decedents age 45–64 (N = 34,208; 25,640 males [75%] and 8568 females [25.0%]). The 45–64 age group had the highest rate of JFH (22.0% for males and 15.1% for females) as a suicide precipitant. The results of generalized linear models for all adult suicide decedents of both sexes showed that the 45–64 age group (IRR = 2.02, 95% CI = 1.89–2.16), compared to 65+ age group, and relationship problems, mental disorders, and alcohol problems were associated with significantly higher risk of JFH-precipitated suicide. In male decedents age 45–64, JFH was positively associated with depressed mood (IRR = 1.95, 95% CI = 1.85–2.06), alcohol problems (IRR = 1.14, 95% CI = 1.07–1.21), and number of crises (IRR = 1.48, 95% CI = 1.43–1.53). In female decedents age 45–64, JFH was positively associated with relationship problems (IRR = 1.19, 95% CI = 1.05–1.35), legal problems (IRR = 1.27, 95% CI = 1.06–1.54), depressed mood (IRR = 1.78, 95% CI = 1.59–1.99), and number of crises (IRR = 1.58, 95% CI = 1.48–1.68). In both sexes, the risk of JFH was also positively associated with a college education. In female decedents, JFH risk was higher among divorced or never-married individuals. Coroner/medical examiner and law enforcement agency reports show that some experienced depression and started misusing alcohol and/or other substances following a job loss, but others had these problems throughout life, which caused/contributed to JFH. These findings show the significance of suicide prevention approaches at both systemic (generous unemployment insurance, housing subsidies) and individual (treatment of depression and alcohol/substance misuse problems and social support/connection) levels.

О создании системы антикризисного управления на предприятии в условиях неопределенности

The threat of business interruption is always present and it is believed that the number of crises is increasing. Since the spring of 2020, the world has faced a rare crisis: a previously unknown virus (COVID-19) has been discovered. The situation was harder to handle than traditional crises. The crisis is often viewed as a negative phenomenon, there is a close relationship between crisis and change, which reflects the positive crisis momentum for the successful development of the company. The research objective is to substantiate the need to create an anti-crisis management system at the enterprise by analyzing the typology of modern crises and to highlight new areas of modern business models in order to maintain the sustainability and development of the enterprise. Methods. With the help of trend, comparative and factor analysis, a number of conclusions and generalizations were made. Results. When choosing a crisis strategy, crisis diagnostics helps: the components of crisis management are highlighted, including an analysis of the situation, a crisis headquarters, schemes and algorithms for eliminating problems, directions for restoring the work of the organization, financial indicators, global and point goals, resources for achieving goals, communications. The priority principles for the implementation of anti-crisis measures are formulated: adaptability, synergy, advanced management, prompt response, rationality. On the basis of the studied domestic and foreign experience, crises possible in modern conditions are classified, their essence, causes and response measures are highlighted: financial, technological, personnel, organizational, technogenic. To assess the strength and suitability of the existing system of crisis management, questions for managers' self-questionnaires are formulated. Companies today need to be stable and dynamic. New areas of modern business models are summarized: the transition to fully digital technologies, the development of new business lines, virtual and digital sales models - for example, the virtual experience of consumers in product deve¬lopment and testing, alternative sources of supply for risk management. Conclusion. It is emphasized that dramatic changes are happening too fast for companies to continue with traditional annual strategic planning – it is necessary to move to monthly strategic meetings to review existing portfolios of planned strategic steps and update them as new opportunities arise or external conditions change.

State and Features of Socio-economic Modernization of the Republic of Belarus

Today the issues and problems of socio-economic development of the Republic of Belarus, its modernization, the use of tools for implementing theoretical, methodological and practical aspects of the national economy development, macroeconomic regulation in the country in the context of performing tasks of a socio-economic nature, institutional mechanisms for ensuring sustainable economic growth of Belarus remain extremely relevant and contain considerable potential for further scientific research.
 Over the 30 years of its independence, the Republic of Belarus has experienced a decline in the 90s of the twentieth century, caused by the severance of socio-economic ties with other components of the unified state before, as well as a number of crises that had a political basis of external and internal nature. Based on this, the need for modernization of the country became more acute for the legislative and executive authorities. The agenda includes improving the macroeconomic situation in the Republic of Belarus in the context of fulfilling the tasks of socio-economic development. Institutional mechanisms to ensure sustainable economic growth continue to require change and development.
 A program-based approach to socio-economic modernization is recognized as one of the main elements for solving the set of tasks in the Republic of Belarus. Given the importance and determining role of the manufacturing sector in the formation of the country’s GDP and the role of economic balance, the need for state support for production and infrastructure facilities that can serve as the basis for rapid economic recovery is proved.
 Based on the conducted research, there is drawn attention to potential risks for the national economy and directions for their neutralization, certain aspects of the country’s external partnership, are considered, as well as demographic development of the state in the context of its impact on the development of Belarus in the future. There are noted positive and negative aspects of the development of the modern Belarusian State.

Pregnancy in Women with Sickle Cell Disease

▪IntroductionSickle cell disease (SCD), characterized by recurrent crisis due to vaso-occlusion, results in acute morbid outcomes and cumulative organ damage. Acute hemolysis typically occurs in times of stress such as pregnancy. Although advances in the management of SCD complications have allowed most women with SCD to reach their reproductive age (Telfer et al. Haematologica.2007), pregnancies can be complicated; increased risks of preeclampsia, maternal death, stillbirths, preterm deliveries and small-for-gestational-age newborns have been reported (Oteng-Ntim et al. BJH.2014).The objective of our study is to assess maternal-fetal complications and vaso-occlusive crisis during pregnancy.MethodsThis is a retrospective chart review of twelve pregnancies in nine women (ages 22-34) with sickle cell disease over a 10 year period at a large urban hospital. All women had a documented history of sickle cell disease (HbSS, HbSC or HbSBthal), and met the inclusion criteria of consistent follow up with hematology for a 3 year span encompassing the year prior through the year after pregnancy. Women were excluded if they had a miscarriage, or were non-compliant with care. Number of crisis, method of delivery, fetal complications were collected.ResultsOf the twelve pregnancies, ten (83%) occurred in HbSS disease patients while two (17%) in HbSC patients. Ten out of twelve pregnancies had at least one crisis in the year prior pregnancy (baseline crisis); of these 60% had the same number of crisis during pregnancy. Interestingly, only 33% of the pregnancies had increase from their baseline crisis in the year after pregnancy.Three pregnancies received prophylaxis exchange after a crisis admission early in the pregnancy and were noted to not have any further crisis. Of nine remaining pregnancies, seven required urgent red cell exchange; two for crisis/preeclampsia, three for acute chest syndrome and two for vaso-occlusive crisis.Overall, 58% of pregnancies had c-section delivery; highest in women that did not receive exchange and lowest in women with prophylactic exchange (33%). Pregnancies that had crisis requiring urgent exchange had 50% rate of c-section. Three preterm deliveries and all fetal complications were noted in patients who had required urgent exchange. Fetal complications included intra-uterine growth retardation (17%), NICU admission (25%), and one fetal demise.ConclusionMedStar Washington Hospital Center is an urban hospital that cares for a large population of sickle cell patients however, due to sporadic follow up in our sickle cell population; data regarding maternal and fetal outcomes in pregnant patients is limited.All pregnancies with baseline crisis will have atleast the same number of crisis during pregnancy. Rates of C-section were noted to be much less (33%) in pregnancies receiving prophylaxis exchange, which is near national average (32.6%) in healthy women (CDC, 2013). Fetal complications were also more prevalent in pregnancies with crisis requiring urgent exchange. Therefore, we conclude that maternal complications such as acute crisis requiring hospitalizations and C-section as delivery modality, and fetal complications can be prevented with prophylactic exchange. DisclosuresNo relevant conflicts of interest to declare.

The Impact of Risks on the Choice of Household Financial Strategies in the Context of the COVID-19 Pandemic

The article examines the features of the influence of various risks on the determination of the financial strategy of households. During the analysis of scientific literature on this issue, it was revealed that the concept of “financial strategy” is often identified with the concept of “financial behavior” of households. The lack of fundamental research on this topic is predetermined by the fact that in our country, for a long period, relations between economic entities were built on the basis of an equalizing distribution, which did not allow the population of our country to develop a model of financial behavior that allows assessing the risks of reduction or loss of income and savings. In addition, a number of crises that the domestic economy went through after the collapse of the USSR influenced the growth of mistrust in financial institutions. In this regard, a low level of objective assessment of the risks existing for household finances is recorded. In addition, in the context of the COVID-19 pandemic, all economic indicators have shifted, and at the same time, risks such as job loss and depreciation of savings have increased. The author came to the conclusion that in these conditions, the choice of the financial strategy of households should be aimed at preserving the existing income and savings, while the investment strategy becomes especially risky, and therefore it is not possible to predict the actual results.

Sleep Patterns and Associated Clinical Correlates Amongst Ghanaian Individuals with Sickle Cell Disease

▪Background: Sickle cell disease (SCD) is the most commonly inherited blood disorder that affects 1 in 500 individuals of African descent worldwide and 70,000-80,000 individuals in the United States. While the molecular basis and progression of this condition has been well established, the association between sleep, stress and frequency of complications such as pain crises has not been well studied. In this study, we investigate how sleep behavioral patterns are associated with the severity and incidence of sickle cell crises amongst patients with SCD.Methods: Adult individuals with SCD were recruited from the Korle Bu Teaching Hospital in Accra, Ghana as participants for this study. No compensation was provided. Participants completed a questionnaire that assessed SCD disease severity such as frequency of pain crises and need for hospitalization. Self-reported sleep habits, including average hours of sleep both at baseline and during pain crisis were also evaluated. Medical records for each participant were also obtained to establish demographic and genotype information.Results: A total of 308 individuals with SCD were enrolled in the study. Patients were classified according to SCD genotype with 68.6% of individuals with severe genotype (hemoglobin SS or sickle/beta thalassemia), and 31% had mild genotype (hemoglobin SC, sickle/beta plus thalassemia disease). Regarding average sleep per night, 2.4% reported 0-2 hours, 14.4% reported 3-4 hours, 38.8% reported 5-6 hours, 36.8 reported 7-9 hours, and 7.7% reported 10 hours or more. During pain crises, 48% reported 0-2 hours of sleep and 91.1% reported 0-4 hours of sleep per night. A paired sample t-test of average hours of sleep at baseline versus sleep during pain crisis showed a significant decrease in hours of sleep while in pain crisis (t=20.16, p < 0.001). Furthermore, female gender was associated with decreased sleep during pain crises (p = 0.008) compared to their male counterparts. An analysis of all SCD Genotypes revealed average sleep per night at baseline was not associated with frequency of crises per year, pain crises requiring ER/doctor visits nor per pain crises per year requiring hospitalizations. However, within the mild genotype group alone, average hours of sleep during a pain crisis was significantly associated with number of crises per year (r = 0.299, p = 0.04), number of crises/year requiring ER/doctor visit (r = 0.256, p = 0.013), and crises/year requiring hospitalization per year (r = 0.246, p = 0.018). Sleep patterns and pain crises/year measures did not correlate amongst patients with severe genotype.Discussion: Per patient self-report, individuals with SCD experience significant disruption with sleep due to pain crises. Most of the individuals report a significant reduction in average amount of sleep during a pain crisis, suggesting that pain crisis likely plays a crucial role in quality of life amongst patients with SCD. In patient with milder genotypes, worse outcomes (frequent ER/doctor visits, frequent crises, and frequent hospitalizations) are associated with less sleep during a pain crisis. This association suggests that amongst those with mild genotypes, sleep amount likely reflects SCD morbidity. The lack of associated pain crises patterns and sleep within the severe genotype suggests most adult patient regardless of severity report a severe lack of sleep during painful crises. Leg ulcer associated with less sleep during painful crises may reflect the impact of leg ulcers on sleep patterns. A limitation of this study was that data was obtained from a single site which may not reflective of sleep patterns amongst individuals with SCD elsewhere. Future areas of exploration could include evaluation of sleep habits with a validated sleep questionnaire and compared with end organ complications of sickle cell disease. DisclosuresWilson:American Society of Hematology: Research Funding. Asare:Office of Research Innovation and Development (ORID) Research Fund/8/LMG-008, University of Ghana; Doris Duke Charitable Foundation; Burroughs Wellcome Foundation; Phillips Family Donation; Aaron Ardoin Foundation for Sickle Cell Anemia; Vanderbilt Univer: Research Funding. Olayemi:Office of Research Innovation and Development (ORID) Research Fund/8/LMG-008, University of Ghana; Doris Duke Charitable Foundation; Burroughs Wellcome Foundation; Phillips Family Donation; Aaron Ardoin Foundation for Sickle Cell Anemia; Vanderbilt Univer: Research Funding.

Financial instruments – the driving force of the capital market

The article considers the capital market of Kazakhstan, which is interesting for international investors looking for expanded opportunities to make a profit through capital investment. The analysis of the portfolio of companiesresidents of Kazakhstan shows a high closeness to the standards of developed countries. Nevertheless, the country needs serious reforms designed to ensure an increase in the attractiveness of various spheres of investment of finance, transparency and predictability of state policy. There is a pronounced monopoly on demand on the market of investors in Kazakhstan, who are included in the institutional category: there is only one major player, offers are little diversified, IPOs and SPOs are extremely rare. In a crisis situation, the set of financial instruments changes in accordance with the accepted directions and rules of investment. Over the course of a number of crises, traditional low-risk assets have proven the existence of residual investment attractiveness with an average level of return. The situation in the global market is undergoing noticeable changes, including due to the consequences of the pandemic, as well as past crises. In general, the stock market in Kazakhstan should be used to attract both debt financing and equity financing. The active growth of investment retail is hindered by the low investment and financial literacy of the population, and the absence of large-scale IPOs.

The impact of COVID-19 on patients with epilepsy.

The COVID-19 pandemic and social distancing can have adverse impacts on adult people with epilepsy (PWE). To investigate the seizure frequency, the perceived well-being, and the presence of anxiety symptoms in PWE during the COVID-19 pandemic period. Data from a questionnaire on the repercussions of COVID-19 were analyzed in relation to the clinical variables of 114 PWE, with a significance level of p<0.05. There were 26 cases of COVID-19 in PWE and/or family members (22.8%). During the pandemic period, 11 PWE (9.6%) reported an increase in seizures, but unrelated to COVID-19. Also, the number of crises in PWE with previous depressive disorders increased, with differences between epilepsies. Symptoms of depression, impaired well-being, and concern for their lifestyle were significant in PWE with a previous diagnosis of depression. Impaired well-being, increased anxiety, nervousness, and tiredness, and the concern with being infected were mentioned by a high number of PWE in the pandemic. Seizure frequency increased during the pandemic period, a finding associated with clinical variables of epilepsy. PWE with depression had worse perceived well-being. Changes in well-being and increased anxiety and nervousness were frequent in the pandemic.

Evaluation of immunological role of Interferon gamma, Interleukin-10 and CD4+ T lymphocytes in pediatric patients with sickle cell disease

Sickle cell disease (SCD) is a chronic inflammatory disease associated with increased levels of multiple cytokines as interferon gamma (IFN-γ) during vaso-occlusive (VOC) crisis and steady state. Therefore, we aimed to explore theimmunological role of serum IFN-γ, interleukin-10 (IL-10) and CD4+ T lymphocytes in children with SCD at steady state and VOC. This study was conducted on 30 children with SCD (15 at steady state and 15 in VOC) and 30 healthy children as controls. Detailed history, complete physical, clinical examination and laboratory investigations as: complete blood count, serum ferritin, IFN-γ, IL-10 and CD4+ T lymphocytes for all patients were recorded. Results: Significant increase in serum IFN-γ in patients with SCD during VOC compared with patients at steady state and controls (P<0.001). Significant increase in serum IL-10 in patients with SCD at steady state compared with those during VOC and controls (P=0.008 and P=0.04 respectively). CD4 +T lymphocyte decreased in patients with SCD during VOC compared with those at steady state and controls (P<0.001). There was a significant positive correlation between serum IFN-ɣ and number of crisis per year (r=0.648, P=0.0001). Serum IFN-γ was increased in patients with history of frequent crisis per year (P=0.001) and decreased in patients under hydroxyurea therapy (P<0.001). IFN-γ was increased in SCD patients. Increased IFN-γ production in SCD suggesting that functionally activated natural killer cells reflecting a host immunological mechanism leading to antigen antibody activation in SCD. Serum IL-10 increased in SCD patients at steady state. CD4 +T lymphocyte decreased in patients during VOC.

Experiencia y hallazgos en el manejo de la dieta cetogénica en niños con epilepsia refractaria, estudio de 10 casos

Refractory epilepsy is due to that drug-resistant epilepsy in which there is no improvement after the applica-tion of various antiepileptic drugs (AEDs). The Telethon Children's Rehabilitation Center cares for a large population of children with some type of epilepsy. Recently, the application of the home intervention proto-col for the ketogenic diet (DC) has increased. A few years ago, DC was only attended with extreme surveil-lance in a hospital center under rigid schemes. With this background, the objective of this study was to describe the experience and findings of a series of 10 cases of children with refractory epilepsy treated with this DC protocol over the course of at least 1 year. All the cases of children (n = 10) attended at the Telethon Children's Rehabilitation Center, Aguascalientes, Mexico, who were treated with the ketogenic diet between the dates of February 2010 and June 2015, were reviewed by means of an electronic clinical record criteria for refractory epilepsy, as well as surveillance for pediatric neurology and nutrition. The DC home interven-tion protocol was established under the criteria of Lambruschini-Nilo & Gutierrez-Sanchez, where it started with a classic type DC with a 2: 1 ratio during the first week of adaptation and then went on to the 3: 1 or 4 ratio: 1 corresponding according to patient tolerance. The reduction in the number of crises was measured at 3 months and one year after surgery. A one-way ANOVA general linear model with repeated measures was applied to measure the efficacy at 3 months and one year of treatment, finding statistical significance when comparing the results means of the number of epileptic events before the diet (p = <0.006). . The most frequent type of epilepsy was West Syndrome in 4 patients, Lennox Gastaut Syndrome in 3 patients, Severe Myoclonic Epilepsy of Childhood and other types of epilepsy, 3 patients. The most common side effects were constipation in 60% of the population, and the least common were hypoalphalipoproteinemia-like dyslipidemia in 30%, reflux in 20%, and kidney stones in 10%.

Depoliticising Gender Equality in Turbulent Times: The Case of the European Gender Action Plan for External Relations

Since more than a decade, the EU is confronted with a number of crises that significantly changed the environment under which the EU operates in the field of gender equality. Evidence shows, that in many European countries, the different crises have led to a deprioritisation of gender equality policies. However, the way in which the new Gender Action Plan for External Relations 2015–2020 of the European Union addresses and operationalises gender equality suggests in contrast a policy shift towards an intensified commitment and more comprehensive understanding of gender. Against this background, this article analyses, first, how the content and the conceptual orientation of gender equality policies in European Union’s external relations have changed in the light of post-crisis recommendations. Second, the article scrutinises the ways in which the European Union tries to tackle the credibility crisis through increasingly intensified and operationalised policy procedures. The argument put forth is that the gender-related indicators in the Gender Action Plan translate complex societal processes into a technical data-based framework and thereby depoliticise gender equality by simulating a technocratic, evidence-based and quantified form of politics.

SEARCHING FOR NEW AUTHORITARISM IN THE CONDITIONS OF GEOPOLITICAL TURBULENCE

The main factors of the growing popularity and influence of undemocratic regimes are considered. In the modern world, in the context of geopolitical turbulence, the geopolitical centers of power and actors in the adoption of global management decisions are changing. But there is a need to manage socio-political and economic processes for the stable development of society. Therefore, the conditions of chaos only strengthen the attempts to search and create fuses for the uncontrollability of the development of the political regime. Especially in the conditions of the crisis of the formal institutions of liberal democracy, a clear proof of which was the emergence of post-democracy as a phenomenon and process of evolution of «modern» democracies. Several factors reinforce this trend. First of all, the reverse wave of democratization (S. Huntington), which lasts several decades. Secondly, the crisis of American hegemony and the completion of the next cycle of political hegemony. We must add the completion of the macrohistorical cycle of the internal political development of the political system of the USA itself (A. Schlesinger) with a number of crises throughout the entire first half of 2020. The weakening of the global hegemon resulted in the process of easternization and the emergence of new geopolitical centers (primarily, Asia, namely China with a powerful economy, which is a prerequisite for the formation of a new hegemon). The third factor is the growth of right-wing extremism and right-wing populism in countries of sustainable democracies and new democracies. The wave of populism is supported by a conservative turn in the form of legal consolidation of nationalism, the legitimation of the dominance of the collective over the individual. Another factor of destabilization is the crisis of traditional institutions of democracy, primarily political parties, party leaders who can refuse program promises and turn into lawyers of the «expression of the will of the people». Amid growing mistrust of traditional democratic institutions and the values of liberalism, there is a growing demand for leaders and institutions that can ensure the safe and stable development of society. And the actual uniqueness of the current development is the search for new forms of coexistence of authoritarian and democratic institutions within the same political regime.

Effect of Age on Healthcare Utilization in Patients with Sickle Cell

Background: The median life expectancy of patients with sickle cell disease surpassed 40 years of age in the last two decades. While sickle cell patients overall are known to have high utilization of health services due to vaso-occlusive pain crises (VOC), few studies have focused on the impact of age on utilization pattern. Due to this, our understanding of the patient population is frequently skewed based on data on younger patients. This study examines the utilization of healthcare in patients in two groups: below 40 years of age, and 40 years and over. We also examined the impact on these two cohorts of a home-based primary care program. Methods: All patients were enrolled in a home-based primary care program in which their primary care doctor visited their home every 4-6 weeks. Health utilization data were collected retrospectively, through chart review for one year prior to joining the home-based primary care program, and prospectively for one year after joining the program. Primary care appointments, reported crises, Sickle Cell Day Hospital visits, ED visits, admissions, 30-day readmissions, and total admission days were recorded. Results: A total of 30 patients was enrolled in the study, and 58 years of data were collected. There were 16 patients between 18 and 39, and 14 patients aged 40 and over. 50% of the 40 and over age group was SS genotype and 50% SC compared to only one patient in the below 40 population had genotype SC. The groups were not significantly different regarding gender distribution (57% female in the 40 and over population vs 50% female in the below 40 population). The 40 and over population had on average more comorbidities per patient. The 40 and over population had significantly more primary care visits every year both before and after the start of the home visits compared to the below 40 population,. The 40 and over population, also had significantly lower overall rates of acute care utilization than the patients under 40: number of crises, ED visits, admissions, 30-day readmissions, and total hospital admission days. When comparing pre and post home visiting within the 40 and older population, there was an increase in primary care visits and a decrease in in reported crises, ED visits, admissions and readmissions. There was no change in these parameters in the 18-39 year old patient group. Discussion: As sickle cell patients age, they are more likely to have cumulative co-morbidities due to their sickle cell disease. Despite their more advanced age and their increase in co-morbid conditions, patients 40 and above were shown in our study to have fewer ED visits and admissions than younger patients, and to further reduce ED visits and admissions when provided with home-based primary care. The younger group had higher utilization at baseline, and did not show improvement when receiving home-based primary care. The reduced acute care utilization in the older group could be due to increased use of primary care, which was further enhanced by enrollment in the home-based primary care program; better adherence to medical treatment; more skill and experience in disease self-management; better social support; or fewer vaso-occlusive crises despite a higher number of co-morbid conditions. The higher prevalence of SC disease in the older cohort is a possible confounder. Those patients with higher utilization at a younger age may be higher risk of mortality, thereby leading to a survivor effect in the older population. Research in the general medical population has shown that home-based primary care reduces acute care utilization in high-utilizing patients with multiple chronic conditions, but more research is needed on the impact in sickle cell patients. Conclusion: This is the first study, to our knowledge, of the impact of home-based primary care on adults with sickle cell disease. In this study, sickle cell patients aged 40 and under showed overall more acute care utilization than those over age 40. The older population had an increase in primary care visits, and overall a significant decrease in healthcare utilization after enrollment in the home visiting program. We did not see a significant decrease in utilization in the younger population with home visits. Disclosures Desai: Global Blood Therapeutics: Membership on an entity's Board of Directors or advisory committees, Research Funding; Ironwood: Other: Adjudication Board; University of Pittsburgh: Research Funding; Novartis: Research Funding; Pfizer: Membership on an entity's Board of Directors or advisory committees, Research Funding; Potomac: Speakers Bureau.

Incidence of Vaso-Occlusive Crisis Does Not Increase with Achieving Higher Hemoglobin Levels on Voxelotor Treatment or after Discontinuation: Analyses of the HOPE Study

Incidence of Vaso-Occlusive Crisis Does Not Increase with Achieving Higher Hemoglobin Levels on Voxelotor Treatment or after Discontinuation: Analyses of the HOPE Study

Balancing and stabilizing South Asia: challenges and opportunities for sustainable peace and stability

Purpose This paper aims to elaborate in a greater detail about how to manage and eventually help resolve outstanding issues, including the core issue of Kashmir between nuclear India and Pakistan. In doing so, this paper elaborates various innovative measures that could be applicable to South Asian nuclear environment that in turn could assist the South Asian nuclear leadership in understanding and managing the fragility of South Asian nuclear deterrence. Design/methodology/approach Innovatively, this research paper looks at the South Asian nuclear issues at three levels of analysis – understanding the prevailing dynamics of nuclear revolution and improved means of communications and promoting deterrence stability in South Asia. All three levels may be more needed than ever before in the wake of the arrival of nuclear weapons for a broader Southern Asian region. Findings This paper finds out that although nuclear weapons have become a reality in South Asia and these deadly weapons have prevented major wars between India and Pakistan, nuclear weapons have not prevented the crises between India and Pakistan. Therefore, both India and Pakistan have confronted a number of crises. The paper finds out that any serious crisis between India and Pakistan could further undermine the credibility of existing confidence-building measures and the same could escalate from military to nuclear level. Absent from immediate measures undertaken by the South Asian security leadership, nuclear weapons may not help prevent the war between India and Pakistan at the sub-conventional level, this paper finds out. Originality/value By explaining innovative measures at the three level of analysis, this papers adds to the existing literature in understanding the behavior of South Asian security leadership and how these measures could best bring positive results in preventing a major crisis that potentially bears the risk of escalation to nuclear level.