Pacific Countries Research Articles

Monitoring and Treatment of Paroxysmal Nocturnal Hemoglobinuria in Patients with Aplastic Anemia in Asia: An Expert Consensus

Paroxysmal nocturnal hemoglobinuria (PNH) clones can be identified in a significant proportion of patients with aplastic anemia (AA). Screening for PNH clones at the time of an AA diagnosis is recommended by national and international guidelines. In this report, an expert panel of physicians discusses current best practices and provides recommendations for managing PNH in patients with AA in the Asia–Pacific region. Plasma/serum lactate dehydrogenase (LDH) levels and reticulocyte count should be measured with every blood test. PNH clone size should be monitored regularly by flow cytometry, with on-demand testing in the event of a rise in LDH level ± reticulocyte count or development of symptoms such as thrombosis. Monitoring for PNH clones can guide the choice of initial AA treatment, although flow cytometry has resource implications which may present a challenge in some Asia–Pacific countries. The treatment of patients with both PNH and AA depends on which condition predominates; following PNH treatment guidelines if hemolysis is the main symptom and AA treatment guidelines if bone marrow failure is severe (regardless of whether hemolysis is mild or moderate). The expert panel’s recommendations on the monitoring and treatment of PNH in patients with AA are practical for healthcare systems in the Asia–Pacific region.

Impacts of Agricultural CO2 Emissions, Agricultural Exports and Financial Development on Economic Growth: Insights from East Asia and Pacific Countries

Impacts of Agricultural CO2 Emissions, Agricultural Exports and Financial Development on Economic Growth: Insights from East Asia and Pacific Countries

The Geopolitical Imaginaries in Moby-Dick; or, The Whale and Hakugei: Legend of the Moby Dick

This paper explores the geopolitical imaginaries in Herman Melville’s Moby-Dick; or, The Whale (1851) and in the Japanese science fiction animation titled Hakugei: Legend of the Moby Dick (1997-1999) by the Japanese animation artist Osamu Dezaki. Although it is an adaptation of Moby-Dick, the setting of Hakugei has been creatively changed from the sea to space. In the mid-nineteenth century, when Melville chose the sea as the setting of his quest novel, the sea was inextricably intertwined with the nineteenth-century myth of U.S. expansionism. Melville presents a double vision of imaginary islands in the South Sea and the actual geopolitical relationships between existing transatlantic countries. Yet in the second half of the twentieth century, especially in the wake of Transpacific tensions, the sea as a place of quest among Japanese writers could not be delineated in the same kind of prefigurative language used by Melville, such as by drawing on symbolism. Instead, the animation reflects a Cold War psychology that was prevalent among Japanese after the defeat of World War II. As this paper suggests, Hakugei displays both fear and hope for the geopolitical transformation of the Pacific Rim countries and their future safety by choosing outer space as a site for the fable. It is in this way that the Japanese animator Dezaki draws on Melville’s Moby-Dick as a source text by engaging geopolitics, anti-war psychology, and uneasiness toward expansionism. Melville’s pacifism can be argued for as major transcultural influence, at the very least, driving Hakugei’s anime characterization. In fact, going beyond drawing on certain characters, including Ahab, Dezaki retains Melville’s anxiety over the proximity of creation and destruction in yet another era of increasing concern for world peace.

An examination of Pacific nations ‘legislatures’ interactions with Supreme Audit Institutions and the impact on audit quality

Purpose The purpose of this paper is to report a study of public accountability within the political and economic structures that characterise Pacific nations. The authors examine audit quality with respect to Pacific Island nations’ governmental reporting to investigate ways to improve accountability in a region that is economically and environmentally challenged. Design/methodology/approach The authors examine whether audit quality in Pacific Island nations is associated with the practical arrangements of Supreme Audit Institutions (SAIs), taking into account external factors. The “practical arrangements” include the independence of a SAI (regarding its staffing and funding) and also the requirement for it to report to the Executive. The financial setting in each jurisdiction has been seen to impact the quality of financial reporting and auditing. The authors examine mediating factors such as income, political stability and education that may also impact audit quality. This study uses publicly available databases as well as jurisdictional annual reports and the associated audit opinions and management letters (where available). Jurisdictional reports on public financial management were also analysed. Findings The authors find that public sector audit quality is low in many Pacific countries, concluding that public accountability is impaired. While the authors recommend changes to the practical arrangements that can improve audit quality, the mediating factors also impact audit quality. They argue that a renewed focus on financial capability could enhance public accountability in these nations, but there are limiting factors that are difficult to overcome. Practical implications There are problems in providing accountability for public sector activities in Pacific nations. The authors suggest that improvements to the appointment and funding of SAIs to enhance their independence will help to reduce these issues. Originality/value The authors present a framework for analysing SAIs’ practical arrangements and audit quality that includes variables that may mediate the effects of these practical arrangements. They apply the model to 20 Pacific jurisdictions, showing that the practical arrangements of a SAI directly impact audit quality. Nevertheless, there are instances where audit quality is poor despite good practical arrangements, implying that mediating factors also play a substantial role in determining audit quality of a SAI.

Goal displacement under great-power competition: Control problems at the periphery of the U.S. alliance system

This analysis uncovers how a third tier of semiautonomous security actors prioritize relative influence over strategic goals that often differ from U.S. strategic priorities of competition with Russia and China. Third-tier powers such as the Arctic country the Faroe Islands and the Pacific country Solomon Islands use jurisdiction over nonmilitary security issues such as infrastructure and law and order management as bargaining tools for leveraging influence and attracting resources by cooperating with U.S. adversaries. Goal displacement encourages the U.S. first-tier power to micromanage control problems at the periphery of the U.S. alliance system by enhanced monitoring and interference.

Burden of cardiovascular disease among the Western Pacific region and its association with human resources for health, 1990–2021: a systematic analysis of the Global Burden of Disease Study 2021

A comprehensive profile of cardiovascular disease (CVD) burden and human resources for health (HRH) distribution in the WHO Western Pacific region has yet to be presented. Studies on the relationship between HRH and CVD in this region are limited. We aimed to describe CVD trends and HRH density in the Western Pacific region and explore the association of HRH with CVD burden. Estimates of CVD deaths and disability-adjusted life years (DALYs) were obtained from the Global Burden of Disease Study (GBD) 2021, and the annual density of HRH was retrieved from GBD 2019. We presented trends in CVD burden and HRH density across 31 Western Pacific countries. Spearman rank correlation analysis and generalized linear models were used to examine associations between CVD burden and HRH density. In 2021, CVD caused six million deaths and 125 million DALYs in the Western Pacific region, accounting for 39.4% and 22.5% of all-cause deaths and DALYs. From 1990 to 2021, the number of CVD deaths and DALYs increased by 94.9% and 57.3% in this region, whereas the age-standardized rate of CVD deaths and DALYs declined in all countries. In 2021, stroke and ischemic heart disease were the leading causes in the Western Pacific region, and a 32-year increase in CVD burden was primarily driven by aortic aneurysm, lower extremity peripheral arterial disease, endocarditis, and atrial fibrillation and flutter. In 2019, there was an approximately 20-fold difference in HRH density across 31 countries from the lowest in Papua New Guinea to the highest in Australia. HRH density was negatively related to the age-standardized rate of CVD deaths (r s =-0.74) and DALYs (r s =-0.73), especially strong associations between CVD burden and the density of dentistry personnel, aides & emergency medical workers, and medical laboratory technicians. CVD remains a pressing public health issue in the Western Pacific region where noticeable shortages in health workers exist. The negative associations between CVD burden and HRH density suggest that health workers, especially dentistry personnel, aides & emergency medical staff, and medical laboratory technicians merit more investment to reduce the CVD burden. National Natural Science Foundation of China (82073573 to ZZ; 82273654 to YS).

Genomic identification of Oryctes rhinoceros nudivirus isolates, a biocontrol agent for coconut rhinoceros beetle

The coconut rhinoceros beetle (Oryctes rhinoceros, CRB) is a serious pest of coconut and oil palms. It is native to South and Southeast Asia and was inadvertently introduced to Samoa in 1909. It has invaded many other Pacific countries throughout the last century. Oryctes rhinoceros nudivirus (OrNV), a natural pathogen of CRB in its native range, was successfully introduced as a classical biocontrol agent and has effectively suppressed invasive CRB populations for decades. However, resurgence of CRB has been recorded, with new invasions detected in several Pacific Island Countries and Territories. Additionally, new populations of CRB are emerging in some invaded areas that have a degree of resistance to the virus isolates commonly released for CRB biocontrol. Here, we designed a fast and reliable tool for distinguishing between different OrNV isolates that can help with the selection process to identify effective isolates for management of new CRB invasions. A comparison of 13 gene/gene region sequences within the OrNV genome of 16 OrNV isolates from native and invaded ranges allowed us to identify unique Single Nucleotide Polymorphisms (SNPs). With these SNPs, we developed an assay using multiplex PCR-amplicon-based nanopore sequencing to distinguish between OrNV isolates. We found that as few as four gene fragments were sufficient to identify 15 out of 20 OrNV isolates. This method can be used as a tool to monitor the establishment and distribution of OrNV isolates selected for release as biocontrol agents in CRB-infected areas.

Cocoa Pod Husk Meal as a Feed Ingredient for Livestock

ABSTRACTCocoa pod husk (CPH) is a by‐product of cocoa. Whilst this by‐product is converted into animal feed in some countries, it is largely left to decompose and cause environmental issues in most South Pacific countries, including Vanuatu. The husk represent 70%–80% of the whole fruit. Its use as animal feed is limited by the presence of antinutritional factors, of which, theobromine is the most prominent. Other antinutritional factors include tannin and phytate. Feeding value of the CPH is improved by reducing these antinutritional factors through broiling, alkaline, and microbial treatment. Exogenous feed enzymes are used to hydrolyze crude fiber. Up to 10% of this by‐product is included in broiler feed and 15% with supplementation of exogenous feed enzymes in layer feed. In pigs, up to 20% can be included into diets of both the sow and growing pig. In ruminants, up to 35% can be used in cattle diet if treated with urea, molasses and/or fermented. The by‐product is widely used as an ingredient and/or energy/protein sources in Africa and Asia. There is scanty literature on its use in the South Pacific countries. In this review, I compiled existing literature on its chemical composition, use in livestock and poultry diets, and existing strategies to improve feeding value. The aim of this review is to project cocoa pod husk meal (CPHM) as a potential feed ingredient as well as energy/protein sources for livestock and poultry in the South Pacific countries, including Vanuatu.

Prevention of HIV/AIDS Transmission in Key Communities in Surabaya

Indonesia is in third place among Asia Pacific countries for the growth and spread of HIV with a total of 46,000 cases. East Java Province is designated as an area with concentrated HIV prevalence along with five other provinces, namely DKI Jakarta, Papua, Bali, Riau and West Java. Knowledge is one of the predisposing factors in early detection of HIV disease, as well as risky behavior that can cause HIV AIDS transmission. This research aims to provide education to key communities as an effort to increase knowledge about HIV AIDS prevention and transmission. This research takes the form of experimental research, namely by measuring the increase in respondents' knowledge through pretest and posttest after the intervention. The intervention takes the form of providing education related to knowledge of preventing HIV/AIDS transmission. The intervention that will be carried out to increase knowledge about safe sexual behavior and preventing HIV AIDS transmission will be carried out by providing education on preventing HIV AIDS transmission in key communities at the Mahameru Foundation for 40 respondents. Risky sexual behavior such as having sexual relations with irregular partners, not using condoms during sexual intercourse, having sexual relations under the influence of alcohol and drugs are still carried out by key communities. The level of knowledge regarding risky sexual behavior, how HIV AIDS is transmitted and how to prevent HIV AIDS before education is carried out is still low.

Extreme dynamic connectedness and hedging strategy across commodity, bond, currency, and stock markets: Evidence from Asian Pacific, Canada, Mexico, and US countries

This study investigates the interconnections among green bonds, non-green bonds, the US Dollar Index, precious metals (gold and silver), the Dow Jones Commodity Index (DJCI), and stock markets in the Asia-Pacific region (including Australia, China, Japan, Malaysia, Philippines, Russia, Singapore, South Korea, and Thailand), Canada, Mexico, and the United States. Additionally, the research delves into the costs and effectiveness of hedging in a diversified stock portfolio. The findings unveil a substantial presence of significant spillovers across these markets. Green bonds, the US Dollar Index, DJCI, gold, silver, and the stock markets of Canada, Mexico, and the US are identified as net contributors to spillovers, while Asia-Pacific stock markets are recognized as net receivers of shocks. The spillover magnitude exhibited a moderate level pre-pandemic, experienced an upward trend during the COVID-19 and Russian-Ukraine conflict periods, and declined during the vaccine distribution phases. The impact of COVID-19 on spillover magnitude appears to be more pronounced than that during the Russia-Ukraine tension. Furthermore, the overall connectedness is observed to be dynamic over time, displaying sensitivity to crisis periods.

Characterization and screening of new Metarhizium isolates to control the coconut rhinoceros beetle in the Pacific islands

The coconut rhinoceros beetle (CRB; Oryctes rhinoceros) is one of the most destructive insect pests of coconut and oil palms in tropical Asia and the Pacific islands. Members of a new variant, known as CRB-G (clade I), have recently spread into the Pacific islands, causing significant damage. Biopesticides containing Metarhizium spp. are the strongest candidates for inundative biological control against the emerging CRB threat. Selection of the most virulent and robust isolate may determine the impact of this control option on the pest. In this work, CRB specimens with natural fungal infection were collected in Papua New Guinea (PNG) and Solomon Islands (SI). Putative entomopathogenic fungi were isolated and identified. These new isolates and some previously obtained from other Pacific countries were molecularly identified, characterized, and tested for virulence against CRB larval populations in PNG and SI in laboratory bioassays. Of the new isolates collected, four obtained from SI were identified as Metarhizium majus (conidia length ⁓11–15 μm), and four from PNG were identified as Metarhizium pingshaense (conidia length ⁓4–6 μm). The most virulent isolate was M. majus AgR-F717, which caused 100 % mortality in 20–23 days against a CRB variant from the CRB-S grouping (clade II) in laboratory bioassays carried out in PNG. Isolates of M. pingshaense did not show pathogenicity against CRB larvae. M. majus AgR-F717 was also the most virulent in laboratory bioassays using the mixed SI population (from both CRB-S and CRB-G groupings) and was selected for further evaluation using artificial breeding sites. Under field conditions, this isolate demonstrated its ability to infect CRB, dispersal up to 100 m from treated artificial breeding sites, and persistence in soil for at least four months. The new isolate AgR-F717 of M. majus has demonstrated potential as an augmentative biological control agent for CRB in PNG and SI.

Social Vulnerability and Compliance With World Health Organization Advice on Protective Behaviors Against COVID-19 in African and Asia Pacific Countries: Factor Analysis to Develop a Social Vulnerability Index.

COVID-19 protective behaviors are key interventions advised by the World Health Organization (WHO) to prevent COVID-19 transmission. However, achieving compliance with this advice is often challenging, particularly among socially vulnerable groups. We developed a social vulnerability index (SVI) to predict individuals' propensity to adhere to the WHO advice on protective behaviors against COVID-19 and identify changes in social vulnerability as Omicron evolved in African countries between January 2022 and August 2022 and Asia Pacific countries between August 2021 and June 2022. In African countries, baseline data were collected from 14 countries (n=15,375) during the first Omicron wave, and follow-up data were collected from 7 countries (n=7179) after the wave. In Asia Pacific countries, baseline data were collected from 14 countries (n=12,866) before the first Omicron wave, and follow-up data were collected from 9 countries (n=8737) after the wave. Countries' socioeconomic and health profiles were retrieved from relevant databases. To construct the SVI for each of the 4 data sets, variables associated with COVID-19 protective behaviors were included in a factor analysis using polychoric correlation with varimax rotation. Influential factors were adjusted for cardinality, summed, and min-max normalized from 0 to 1 (most to least vulnerable). Scores for compliance with the WHO advice were calculated using individuals' self-reported protective behaviors against COVID-19. Multiple linear regression analyses were used to assess the associations between the SVI and scores for compliance to WHO advice to validate the index. In Africa, factors contributing to social vulnerability included literacy and media use, trust in health care workers and government, and country income and infrastructure. In Asia Pacific, social vulnerability was determined by literacy, country income and infrastructure, and population density. The index was associated with compliance with the WHO advice in both time points in African countries but only during the follow-up period in Asia Pacific countries. At baseline, the index values in African countries ranged from 0.00 to 0.31 in 13 countries, with 1 country having an index value of 1.00. The index values in Asia Pacific countries ranged from 0.00 to 0.23 in 12 countries, with 2 countries having index values of 0.79 and 1.00. During the follow-up phase, the index values decreased in 6 of 7 African countries and the 2 most vulnerable Asia Pacific countries. The index values of the least vulnerable countries remained unchanged in both regions. In both regions, significant inequalities in social vulnerability to compliance with WHO advice were observed at baseline, and the gaps became larger after the first Omicron wave. Understanding the dimensions that influence social vulnerability to protective behaviors against COVID-19 may underpin targeted interventions to enhance compliance with WHO recommendations and mitigate the impact of future pandemics among vulnerable groups.

Correction: Public attitude toward solar radiation modification: results of a two-scenario online survey on perception in four Asia–Pacific countries

Correction: Public attitude toward solar radiation modification: results of a two-scenario online survey on perception in four Asia–Pacific countries

Towards sustainable initiatives: Evidence from green finance mitigating ecological footprint in East Asia and Pacific nations

Green finance serves as a bridge between development and ecological sustainability. It provides a roadmap for countries to accomplish sustainable development goals by simultaneously curbing their ecological footprint. Green financing prioritizes eco-friendly technologies, sustainable behaviors, renewable energy, and green infrastructure, promoting positive changes. This study examines the role of green finance on the ecological footprint of 11 East Asian and Pacific countries from 2000 to 2023. This study uses different diagnostic tests to prove the existence of cross-sectional dependency, non-normality, and slope heterogeneity. The coefficients are estimated using the fully modified ordinary least squares (FMOLS) approach and panel quantile regression at different quantiles. The results show the validity of an inverted U-shaped relationship between green finance and the ecological footprint. Further analysis explores that at the middle quantile, all selected countries except Mongolia and the Philippines, while the FMOLS approach shows that all countries’ green finance reduces their ecological footprint. Additionally, globalization reduces the ecological footprint, while economic growth, industrialization, and urbanization increase the ecological footprint. This study recommends that to fight against climate change, the selected countries should focus more on green finance. Financial institutions should provide funds only for environment-friendly technologies.

The burden of non-alcoholic fatty liver disease among working-age people in the Western Pacific Region, 1990–2019: an age–period–cohort analysis of the Global Burden of Disease study

BackgroundThe growing prevalence of non-alcoholic fatty liver disease (NAFLD) in younger populations, particularly those of working age (15–64 years), has become a public health concern. Being diagnosed at a younger age implies a greater likelihood of accruing disability-adjusted life years (DALYs) later in life due to potential progression to conditions such as cirrhosis or hepatocellular carcinoma. This study aims to analyze NAFLD prevalence trends over three decades globally, regionally, and nationally, with a focus on age, period, and birth cohort associations.MethodsGlobal, regional, and country time trends in the prevalence of NAFLD among working-age people from 1990 to 2019: Age-period-cohort analysis based on Global Burden of Disease Study 2019 estimates and 95% uncertainty interval (UI) of NAFLD prevalence in the working age population was extracted from the Global Burden of Diseases, Injuries and Risk Factors Study 2019. Age-period-cohort models were used to estimate the prevalence within each age group from 1990 to 2019 (local drift, % per year), fitted longitudinal age-specific rates adjusted for period bias (age effect), and period/cohort relative risk (period/cohort effect).ResultsThe global age-standardized prevalence (ASPR) of NAFLD increased significantly from 1990 (14,477.6 per 100 000) to 2019 (19,837.6 per 100 000). In the Western Pacific, there were 42,903.8 NAFLD cases in 2019, 54.15% higher than in 1990. The ASPR also increased significantly in the region over the past three decades. At the national level, Palau had the highest ASPR while Brunei Darussalam had the lowest. Age-period-cohort analysis showed that in the Western Pacific, unlike globally, the risk of NAFLD declined after age 60–64 years. Relative to 1980–1989, incidence and DALY risks decreased but prevalence increased in subsequent birth cohorts. Future predictions indicate an upward trend in NAFLD burden, especially among women and medium (SDI) regions like China.ConclusionNon-alcoholic fatty liver disease imparts an immense health burden that continues to grow globally and in the Asia Pacific region. Our work highlights working age adults as an at-risk group and calls attention to socioeconomic gradients within Western Pacific countries. Upward future projections demonstrate that NAFLD prevention is an urgent priority.

Neuromodulators in Skin of Color: An International Review.

As the racial/ethnic diversity of the US population grows, it is imperative for dermatologists to recognize the nuances in the aesthetic treatment of diverse populations. This comprehensive review explores the safety and efficacy of botulinum toxin A (BTX-A) in skin of color (SOC) populations and highlights variations in aging patterns, skin properties, and aesthetic concerns in SOC populations. A review of PubMed/MEDLINE databases from 2004 to 2024 was performed using combinations of the terms botulinum toxin, SOC, Fitzpatrick, race/ethnicity, and Asian, Latin American, Caribbean, Middle Eastern, African, and Pacific countries. Twenty-three articles examining the use of BTX-A in SOC populations were identified. Twelve studies were from East Asia, 5 from the United States and/or Canada, 3 from South Asia/Southeast Asia, 2 from South America, and 1 from the Middle East. Available data suggest that BTX-A is efficacious and well tolerated in SOC populations. Increased SOC representation in clinical trials may guide the development of tailored treatment approaches to optimize aesthetic outcomes for patients with SOC. A comprehensive knowledge of the variations in aging patterns, skin properties, and aesthetic concerns across SOC populations is essential for providing culturally sensitive cosmetic dermatologic care for diverse populations.

Analyzing the Impact of China's Belt and Road Initiative on South Pacific Countries' Pursuit of Self-Reliance and Sustainable Development

This study is focusing on analyzing China's Belt and Road Initiatives (BRI) within the broader context of geo-political and geo-economic interests in the Indo-Pacific region. The primary goal is to fill a gap in the academic literature by using analytical tools and methods to gather data from various sources. The collected data is then analyzed within historical and contemporary geo-political contexts to draw conclusions and offer recommendations based on the findings. Received: 26 March 2024 / Accepted: xx month 2024 / Published: 8 July 2024

Influence of Fossil Fuel Prices on Fossil and Renewable Electricity Consumptions, GDP, Inflation and Greenflation: A Case Study in the Asia Pacific Countries

Influence of Fossil Fuel Prices on Fossil and Renewable Electricity Consumptions, GDP, Inflation and Greenflation: A Case Study in the Asia Pacific Countries

Dynamic effects of energy aid in energy transition under the moderating role of the government's regulatory quality

Energy aid to Asia Pacific countries seems attractive for decarbonization and renewable energy transition. However, no clear picture has been drawn on the synergetic connections between the energy aid and the transition to renewable energy in the Sustainable Development Goal 7 (SDG7) paradigm. Therefore, this study is designed to fill this gap by examining the energy aid and its response to energy transition, measuring it with four sub-indicators of SDG7. Using a robust econometric framework, the empirical findings indicated that total energy aid has substantial potential in transitioning to renewable energy, and the link is more pronounced with energy policy aid and renewable energy aid in the Asia Pacific. The response of energy aid through the moderating effect of government regulatory quality on energy transition is also strong. These results carried similar signs and magnitude across the regional panels, estimates with multiple estimators, including asymmetric analysis, making the results robust for theoretical foundations. The novel findings from this study have scope for policymakers to design a practical policy roadmap for the transition of renewable energy to reach a carbon-neutral globe.

Prospects of emerging 3D bioprinting technologies: major startup companies and regulatory issues for human use—part II

Abstract In its highly developed form, the evolving three-dimensional (3D) bioprinting technology aims to create 3D structures with living cells to mimic real tissue and organ functions. It would offer significant benefits across research, personalized medicine, and multiple other applications when adequately developed for human medicine. Presently, more technological activities are witnessed in North America, followed by Europe, Asia Pacific countries, Israel among the Middle East countries, and some South American countries. Around 75 commercial companies are active in 3D bioprinting, with only about a dozen making significant commercial progress. This number is expected to rise phenomenally as breakthroughs in manufacturing and the safe use of 3D bioprinted tissues and organs emerge. Legal frameworks for 3D bioprinting will likely be established, incorporating additions to existing drug laws once countries like the United States of America authorize using 3D bioprinted products in personalized medicine. The demand for 3D bioprinting products is rising based on expectations of future benefits. Therefore, intense research and development activities are ongoing, resulting in demands for the supply of research materials. The legal framework still needs to be put in place for the commercial use of 3D bioprinted tissues and organs in personalized medicine; therefore, laws are to be created for their safe use. This review provides a flavor of the evolution of 3D bioprinting startup companies globally using these technologies.