Respective Figures Research Articles

LIFETIME TREATMENT BURDEN OF PATIENTS WITH MANTLE CELL LYMPHOMA: SIMULATION‐BASED ANALYSIS OF REAL‐WORLD DATA FROM 20 YEARS

Background: Mantle cell lymphoma (MCL) is a rare subtype of B-cell lymphoma that is currently considered incurable, yet treatable condition with increasing amount of treatment options. Alas, the availability of novel therapies is often limited to later treatment lines due to their excessive cost. In this study, we aimed to conduct a baseline analysis on the lifetime treatment burden of MCL patients treated with conventional chemoimmunotherapy regimes. Specifically, we wanted to estimate the number of treatment lines received during 20-year follow-up to determine the number of MCL patients that could potentially receive novel, targeted therapies during the follow-up period. Methods: A real-world data set of 548 patients diagnosed and treated for MCL between the years 2000 and 2020 was collected from seven Finnish hospitals and one Spanish hospital. First, this data was analyzed using the traditional methods of survival analysis for overall survival, time to progression and follow-up time. From these initial results, we estimated the risk of progression from the first treatment line to subsequent treatment lines, to death from MCL, or death from other causes. These estimates were then applied in our competing risk analysis based on Weibull distribution and the data was completed by dynamic imputation of health event histories using discrete semi-Markov transitions in a limited time space to extrapolate the censored variables from our data set up to 20 years of follow-up for each patient. A state distribution plot from our analysis is shown below (Figure 1). Results: In our original data set, the median duration of follow-up was three years (range 0 to 18 years). At 10 years of simulated follow-up, 525 (95.8%) patients had received first-line therapy, 307 (56.0%) had received second-line therapy, 148 (27.0%) had received third-line therapy and 64 (11.7%) had received fourth-line therapy. A total of 262 (47.8%) patients had died from MCL and 113 (20.6%) from other causes. After 20 years of simulated follow-up, the respective figures were 525 (95.8%), 373 (68.1%), 192 (35.0%) and 85 (15.5 %). A total of 362 (66.1%) of patients had died from MCL and 166 (30.3%) from other causes. The median number of treatment lines received both at 10 and 20 years of follow-up was three. Figure 1. State distribution plot from 20-year follow-up The research was funded by: North Ostrobothnia Health Care District Keywords: Aggressive B-cell non-Hodgkin lymphoma, Cancer Health Disparities No conflicts of interests pertinent to the abstract.

Incidental demyelination in magnetic resonance imaging and 10-year risk of multiple sclerosis: A data lake cohort study.

There is an absence of data from large population-based cohort studies on the incidence of radiologically isolated syndrome (RIS). The incidence of RIS and the subsequent risk for multiple sclerosis (MS) were investigated. A population-based, retrospective cohort study was conducted using a data-lake-based analysis of digitalized radiology reports. All brain and spinal cord magnetic resonance imaging (MRI) in people aged 16-70 during the years 2005-2010 (n = 102,224) were screened using optimized search terms to detect cases with RIS. The subjects with RIS were followed up until January 2022. The cumulative incidence of RIS was 0.03% when all MRI modalities were included and 0.06% when only brain MRI was included according to MAGNIMS 2018 recommendation criteria. With the Okuda 2009 criteria, the respective figures were 0.03% and 0.05% (86% concordance). The overall risk for MS after RIS was similar, 32% by using the MAGNIMS and 32% by using the Okuda definition of RIS. Individuals aged <35.5 years exhibited the most significant predisposition to MS (80%), whilst those >35.5 years had less than 10% risk of MS. MS diagnosed after RIS constituted 0.8% of the incident MS cases in the population during 2005-2010. A population-wide context was provided for the incidence of RIS and its relationship to MS. MAGNIMS recommendations were only slightly more sensitive to detect RIS compared to the Okuda criteria. RIS has a subtle effect on the overall incidence of MS, yet the risk for MS in individuals under the age of 35.5 years is substantial.

Total Phenolic Content and Antioxidant Capacity of &amp;lt;i&amp;gt;Dunaliella salina &amp;lt;/i&amp;gt;Were Cultivated Under Stress Conditions on Salt Field Media

<i>Dunaliella salina</i> (<i>D. salina</i>) is a unicellular green microalga with a high β-carotene content and bioactive compounds that is essential for any study of the application of microalgae. The current research aimed to evaluate total phenolic content, and antioxidant capacity of <i>D. salina</i> CCAP 19/18 strain in RM1 and RM2 salt field media under various stress conditions including natural light, high salinity, and nitrogen starvation. As a result, after 17 days of being enrichment, in the RM1 medium, there was no significant difference in phenolic content under natural light, high salinity, and nitrogen starvation stresses, with p = 0.305. Similarly, the antioxidant capacity had no significant difference, which was p = 0.105 (natural light with high salinity), and p=0.428 (nitrogen starvation with high salinity). While in RM2 medium, the phenolic content and antioxidant capacity under nitrogen starvation stress far exceeded that of natural light and high salinity, with respective figures being 157.147 fg acid gallic/cell and 600.443%/cell and these figures had a significant difference (p<0.05). As a consequence, we could choose an appropriate medium for cultivating and harvesting algae in a large-scale pilot. These true potential extract ingredients in algae are fascinating for cosmetic industries or used for various health benefits such as nutraceuticals and medications against damaging causes, particularly free radicals.

Evaluation of Phosphine Resistance in Three Sitophilus Species of Different Geographical Origins Using Two Diagnostic Protocols

Phosphine resistance occurs in many areas worldwide. The present study evaluated Sitophilus species from different geographical origins using two different protocols: (i) the Food and Agriculture Organization (FAO) protocol (30 ppm for 20 h) and (ii) the dose–response protocol (50–1000 ppm for 3 d). According to our results, most of the populations tested were susceptible to phosphine. In the FAO protocol, 13 field populations out of the 35 tested were categorized as resistant to phosphine. From the populations tested, only Sitophilus oryzae (L.) G1 showed 100% active individuals after 20 h or even 7 d post-exposure. In contrast, low survival was noted for all populations of Sitophilus granarius (L.) and no survival for Sitophilus zeamais Motschulsky. Based on the dose–response protocol, no active individuals were recorded after exposure to 700 ppm for any of the populations tested. For instance, the population G1 showed 89% survival after 3 d at 50 ppm, while the respective figure at 700 ppm was 1.1.%. No survival was recorded for all concentrations and populations of S. granarius and S. zeamais. Our data show that there are considerable similarities between the two diagnostic protocols used for the evaluation of phosphine resistance of these three species.

The relationship of income on stroke incidence in Finland and China.

Stroke incidence has continued to increase recently in most countries. The roles of individual-level income on the incidence of overall stroke and its subtypes are still unknown, especially in low- and middle-income countries and the cross-national evidence is also limited. We explored the association between individual-level income and stroke incidence in Finland and China. Changde Social Health Insurance Database (N=571843) and Finnish population register (N=4046205) data were used to calculate standard stroke incidence rates, which were employed to assess the absolute incidence difference between income quintiles. Cox regression was used to compare income differences in first-ever stroke incidence. The highest income quintile had lower overall and subtype stroke incidence when compared to lower-income quintiles. The relative difference was more evident in hemorrhagic stroke incidence. After adjusting for age and employment status, the disparity of stroke incidence between the lowest and highest income quintiles was high among both men and women and in Finland and China. The disparity was particularly notable among men: in Finland, the hazard ratio (HR) for hemorrhagic stroke was 0.633 [95% confidence interval (95% CI) 0.576-0.696] and HR 0.572 (95% CI 0.540-0.606) for ischemic stroke. The respective figures were HR 0.452 (95% CI 0.276-0.739) and HR 0.633 (95% CI 0.406-0.708) for China. Individual-level income is related to overall and subtype stroke incidence. Future studies should explore the causal relationship between individual-level income and stroke incidence.

Politiskās cīņas par Raini un Aspaziju

One of the key responsibilities of the state authority is to win and keep the public’s support for political choices, adherence to requests, etc. Propaganda is a powerful tool for winning over folks’ loyalty. Creative individuals in the world of art and culture frequently participate in the dissemination of an ideological statement. Rainis (1865–1929) and Aspazija (1865–1943) are popular and respected poets and public figures. People are listening to their opinion; therefore, it is in the interests of both independent Latvia and the Soviet occupation authorities to make them their “allies”. In the case of Rainis – even after the death of the poet. The case study of the interaction between poets and state authority in the context of Latvian literature history enables us to understand the tactics used by the state authority to enlist the aid of creative individuals and use them to carry out propaganda objectives. These tactics also included intimidation and subjugation, the spread of purposefully false information, and the concealment of the truth. The study examines the period from the 1920s to the 1970s, concentrating particularly on the first year of the Soviet occupation (1940), and examines the ways in which the names Rainis and Aspazija appear in the official rhetoric of the occupying power – in press materials and fiction. The study also examines how the poets’ works were used to further propaganda goals.

EFFICACY OF THE DRUG «VETLAN» FOR TREATMENT OF ALLERGIC ETIOLOGY DERMATITIS IN CATS

Local treatment occupies an important place in dermatology, since the applied drugs render the therapeutic effect locally on the lesioned skin. This method is often used as complementation to the systemic treatment, thereby shortening a recovery period and giving a veterinary physician an opportunity to reduce the dose and frequency of the main systemic drug. The article presents the results of efficacy evaluation of the drug «VetLan», which is composed on the basis of colloidal silver, nano zinc oxide and lanthanum oxide and intended for treatment of allergic etiology dermatitis in cats. The proposed drug helps to reduce the time and to increase the efficacy of cats treatment when included into a complex therapy. It was found that «VetLan» is efficient in 77.7 % of cases, namely 7 out of 9 cats were cured after application of the drug, whereas the efficacy after application of the drug «Eplan» was 55.5 %. The duration of treatment was 14.2 ± 1.38 days for flea allergic dermatitis, 9.3 ± 2.05 days for atopic skin syndrome. The respective figures for animals in the control group were 18.2 ± 0.68 and 10.6 ± 1.69 days. Compared to the control group, the regeneration of lesioned epithelium in case of flea allergic dermatitis was 1.4–1.6 times faster, in case of atopic skin syndrome 1.3–1.5 times faster. In the course of this study no side effects as of irritation or allergy were found in cats after using the developed drug.

FEA Based Design and Stability Study of Electroless Ni-P Coating Plated over a Stepped Shaft under Thermal Load

ABSTRACT Modelling of Ni-P coating and substrate assembly is done using the finite element analysis framework. Coating having a thickness of 50 µm is applied over a stepped shaft made of stainless steel and analysed in Ansys Workbench at an elevated temperature of 200°C. The thermal effect on the system is studied and results are discussed in detail with respective figures. Elastic modulus of Ni-P coating required for the analysis is evaluated from the nanoindentation test under 10 mN load. The analysis focuses on the evaluation of the critical design parameters such as equivalent stress, total deformation, strain energy and thermal strain over the entire body. Besides, four separate paths are created on the model to study the difference of induced stress and strain energy between the contacting surfaces of the shaft and the coating. It is found that there is a sharp discontinuity in these values and this discontinuity is further interpreted as a measure of the stability of coating over the substrate. It is found that the higher the difference of stress and strain energy, lower is the stability of the assembly which is considered to be realistic and in accordance with the elasticity principles. .

Advanced non-melanoma skin cancer in elderly patients: When surgery says NO, interventional radiotherapy (brachytherapy) says YES.

The prevalence of non-melanoma skin cancer (NMSC) increases, especially in older adults with comorbidities, narrowing radical treatment options. About 5% of skin cancer patients are diagnosed with an advanced stage, which impairs daily functioning. The study was to present a retrospective summary of elderly patients unfit for surgery and treated with various brachytherapy (BT) techniques tailored individually for locally advanced NMSCs in a reference BT department. Clinical case presentations supported the findings. Inoperable patients older than 75 years presenting with advanced pathologically confirmed NMSCs were retrospectively identified. All cases were individually assessed, and the best suiting radical treatment option was chosen, including contact, interstitial, or hybrid high-dose-rate (HDR) or pulsed-dose-rate (PDR) BT. Doses ranging from 45 to 60 Gy were administered to clinical target volume (CTV) in different time schedules. All patients were closely followed-up until complete remission. Ten elderly patients (mean age, 84 years) with differently located locally advanced NMSCs (all staged T3) were treated between 2007 and 2022. Six basal and four squamous cell carcinoma cases showed most painful symptoms as well as bleeding and exudation. Six patients underwent HDR-BT and four PDR-BT. Six patients had superficial, and four interstitial or hybrid applications. All patients completed the intended protocols. Median follow-up was 8.5 months (range, 3-35 months). Six out of ten patients died from other reasons before analysis. All case data were presented in the text and respective figures. Advanced NMSCs in elderly patients are challenging in terms of cure. Inoperable cases may be referred for feasible and locally effective interventional radiotherapy (BT). Individually tailored BT leads to an excellent disease control, function sparing, symptoms release, and quality of life improvement. Large treated volumes are related to prolonged healing. BT should be discussed in a multidisciplinary tumor board regarding older patients with symptomatic functions affecting advanced NMSCs.

2205. Potential Causative Association between Respiratory Viruses and Pneumococcus-Associated Disease in Young Children in Israel: Lessons from the COVID-19 Pandemic

Abstract Background During the early Covid-19 pandemic, we observed a close-to-full disappearance of the activity of 4 respiratory viruses (RSV, hMPV, influenza, and parainfluenza), followed by an off-season sequential re-emergence in 2021. Surprisingly, a striking similarity between the dynamics of pneumococcus-associated disease (PAD; namely community-acquired alveolar pneumonia [CAAP; often considered pneumococcal] and bacteremic-pneumococcal pneumonia [IPD-Pneumonia]), was also observed. In contrast, adenovirus and rhinovirus activities did not change during COVID-19. We examined the association between PAD and RSV, hMPV, influenza, and parainfluenza (PAD-viruses). Methods Surveillance of CAAP and IPD-Pneumonia incidences and viral activity in children &amp;lt; 5 years was described in detail previously [Danino D. et al. Clin Infect Dis. 2022, https://doi.org/10.1093/cid/ciab1014]. We extended the observations until December 2021, to capture the sequential re-emergence of the 4 PAD-viruses. A hierarchical linear regression model was used to quantify the association between PAD-viruses (each virus individually and combined), adenovirus and PAD. After fitting the models, the contribution of each virus was estimated. Results The Figure shows striking similarities in the dynamics of CAAP, IPD-Pneumonia, and PAD-viruses both before and during the COVID-19 pandemic. During the expected peak season (Oct 2020 – Apr 2021) PAD episodes were extremely low. However, off-season peaks were seen during May – Dec 2021. Overall, 78% and 25% of all CAAP and IPD-Pneumonia episodes, respectively, were attributable to these viruses in children &amp;lt; 5 (Table). In CAAP, cases were attributable to each of the 4 PAD-viruses individually throughout the first 5 years of life: RSV and hMPV combined contributed 80%, 63%, and 42% of all CAAP episodes in children aged &amp;lt; 1, 1, and 2-4 years, respectively. The respective figures for influenza and parainfluenza combined were 13%, 21%, and 22%. Only RSV significantly contributed to IPD-Pneumonia (19%). Adenovirus did not contribute to PAD episodes. Conclusion Our model suggests an important causative association between RSV, hMPV, influenza, and parainfluenza viruses and CAAP, and between RSV and IPD-Pneumonia. Disclosures All Authors: No reported disclosures.

Neonate, Infant, and Child Mortality in North Africa and Middle East by Cause: An Analysis for the Global Burden of Disease Study 2019.

During the past three decades, neonate, infant, and child mortality declined in North Africa and Middle East. However, there is substantial heterogeneity in mortality rates across countries. This study is part of the Global Burden of Diseases study (GBD) 2019. We report the number as well as mortality rates for neonates, infants, and children by cause across 21 countries in the region since 1990. Between 1990 and 2019, the neonate mortality rate in the region declined from 31.9 (29.8, 34.0) to 12.2 (11.1, 13.3) per 1000 live births. Respective figures for under 5 mortality rates (U5MRs) were 79.1 (75.7, 82.7) in 1990 and 24.4 (22.3, 26.7) per 1000 live births in 2019. The majority of deaths among children under 5 years were due to under 1 year deaths: 75.9% in 1990 and 81.8% in 2019. Mortality rates in males were higher than females. The mortality rate among neonates ranged from 2.4 (2.1, 2.6) per 1000 live births in Bahrain to 25.0 (21.6, 28.4) in Afghanistan in 2019. Similarly, in 2019, the U5MR ranged from 5.0 (4.2-6.0) per 1000 live births in United Arab Emirates to 55.3 (47.9-63.5) in Afghanistan. Neonatal disorders, congenital birth defects, and lower respiratory infections were the three main causes of neonate, infant, and child mortality in almost all countries in the region. In 2019, most countries in this region have achieved the SDG targets for neonate and child mortality. However, there is still substantial heterogeneity across countries.

Application of a Flow Cytometric Core Marker Set in the Diagnostic Workup of Patients with Suspected Myelodysplastic Syndromes

Background Flow cytometry (FC) performed according to ELN 2012 criteria (Westers et al., 2012) is recommended by ELN guidelines for diagnostic workup in suspected myelodysplastic syndromes (MDS, Malcovati et al., 2013). Recently, the ELN working group on FC in MDS identified 17 core markers independently related to MDS as well as >3% myeloid progenitor cells (MPC) to be strongly related to MDS. In parallel, during the last decade next generation sequencing (NGS) became increasingly relevant for MDS diagnostics. Aim To validate the new ELN criteria (ELN 2022) in comparison to cytomorphology (CM) in an independent cohort of patients prospectively undergoing diagnostics for suspected MDS and their correlation with MDS specific variants as detected by NGS. Methods Bone marrow samples of 4658 patients (female/male, 1833/2825; median age 72 years, range 18-96) with suspected MDS were analyzed in parallel by CM, FC and NGS (73 gene panel). Cases with non-MDS neoplasms were excluded. Results CM and FC (ELN 2012) revealed concordant diagnostic results in 80%. 1342 (29%) cases were diagnosed MDS by both CM and FC (CM+FC+), 2384 (51%) were CM-FC-. Discordant cases were 329 (7%) CM+FC- and 603 (13%) CM-FC+, respectively. Application of ELN 2022 criteria for the diagnostic of MDS by FC (either at least 3 out of 17 markers present or more than 3% MPC) resulted in a similar degree of concordance (78%). 1016 (22%) were CM+FC+ and 2626 (56%) were CM-FC-. Discordant cases were 655 (14%) CM+FC- and 361 (8%) CM-FC+, respectively. Next, we determined the portion of cases with at least one MDS-related gene mutation as analyzed by NGS in cases discordant between CM and FC. Regarding FC ELN 2012 criteria 248/329 (75%) of CM+FC- cases had at least one mutation, while in CM-FC+ cases the rate was 352/603 (58%). Considering ELN 2022 criteria 527/655 (81%) of CM+FC- cases had at least one mutation, while in CM-FC+ cases the rate was 236/361 (65%). Focusing on mutations in detail revealed similar frequencies of CHIP mutations (ASXL1, DNMT3A, TET2) regardless of CM and FC results. Concordant CM and FC cases (ELN 2012) harbor at least one CHIP mutation in 38% (CM+FC+ 506/1341, 38%; CM-FC- 901/2384, 38%). In CM+FC- cases 137/329 (39%) had at least one CHIP mutation, while in CM-FC+ cases the rate was 220/603 (37%). Application of ELN 2022 criteria resulted in a similar distribution (CM+FC+ 379/1016, 37%; CM-FC- 983/2626, 37%; CM+FC- 254/655, 39%; CM-FC+ 138/361, 38%). Analyzing cases discordant between CM and FC regarding non CHIP mutations showed a strong correlation between CM+FC- cases and SF3B1 mutations (ELN 2012: 102/324, 32%; ELN 2022: 190/651, 29%). In contrast, in CM-FC+ cases just 13/597 (2%, ELN 2012) and 11/357 (3%, ELN 2022), respectively, had an SF3B1 mutation. In line with this correlation, CM+FC- cases (ELN 2012) with mutated SF3B1 had ≥5-14% ring sideroblasts (RS) in 17/102 (17%) and ≥15% RS in 78/102 (77%). The respective figure for CM+FC- cases (ELN 2022) were ≥5-14% RS in 22/190 (12%) and ≥15% RS in 160/190 (84%). On the other hand SRSF2 mutations were found in discordant cases slightly more frequently in CM-FC+ cases compared to CM+FC- cases (ELN 2012: 95/557 (17%) of CM-FC+ and 40/315 (13%) of CM+FC- cases). This correlation was even clearer with ELN 2022 criteria (75/334 (23%) of CM-FM+ and 101/628 (16%) of CM+FC- cases). Evaluating remaining cases discordant between CM and FC after excluding those with CHIP mutations, SF3B1 mutations, and SRSF2 mutations revealed no major differences regarding presence of at least one of the remaining mutations (ELN 2012: 32/107 (30%) of CM+FC- cases and 62/275 (23%) of CM-FC+ cases; ELN 2022: 59/175 (34%) of CM+FC- cases and 43/146 (30%) of CM-FC+ cases). Conclusion FC has already proven its power in MDS diagnostics. We here confirm the newly defined criteria of ELN for diagnosing MDS (ELN 2022) to reveal results comparable to ELN 2012 criteria. Thus, a reduced core set of markers is already sufficient for MDS diagnosis by FC without loss in accuracy. Furthermore, cases with results discordant between CM and FC are associated with MDS-related mutations with particular sensitivity of CM in SF3B1 mutated cases and of FC in SRSF2 mutated cases. The higher frequency of mutations in cases discordant between CM and FC applying ELN 2022 criteria as compared to ELN 2012 criteria argues in favor of a higher specificity of the ELN 2022 criteria. Follow-up analyses are indicated to reveal the significance of discordant findings.

Like, share, and remember: Facebook memorial Pages as social capital resources

AbstractThis study focuses on users’ practices involved in creating and maintaining Facebook memorial Pages by adapting the theoretical perspective of the social capital approach. It examines 18 Pages in Israel, which are dedicated to ordinary people who died in nonordinary circumstances. We employ qualitative analysis based on a digital ethnography conducted between 2018 and 2021. Our findings show how memorial Pages serve as social capital resources for admin users. Admins negotiate Facebook affordances when creating, designing, and maintaining such Pages. They discursively position the deceased as a respectable public figure worth remembering and their followers, who are otherwise strangers, as vital partners in this process. The resources followers provide range from economic capital and practical support to solidarity and emotional support. Finally, we point at the perceived connection users make between visible/measurable online engagement (Like, Share, Follow), and cognitive or emotive implications—public memory, recognition, and esteem.

Value of ultrasound and computed tomography in the diagnosis of acute appendicitis with histopathology as gold standard

Background To evaluate the value of ultrasound (US), computed tomography (CT) and laboratory testing in diagnosing acute appendicitis and to evaluate the impact on the treatment of acute appendicitis, keeping histopathology as the gold standard. Retrospective evaluation of all patients treated surgically for appendicitis from 1 January 2016 to 31 December 2018 at Sint-Andries Hospital, Tielt, Belgium. Methods For each patient, we recorded: age, sex, duration of hospitalization, type of radiological investigation, fever (>37.3 °C), C-reactive protein (CRP), leukocyte particle count (LPC), Alvarado score and the type of surgery. For US and CT sensitivity, specificity and negative appendectomy rate were evaluated. Results Over a period of 3 years, 304 appendectomies were performed. The overall prevalence of appendicitis was 95.1%. Mean age was 31 years. All patients underwent radiological examination. US was performed in 35.9% (109), CT in 50.3% (153) and CT after US in 13.8% (42) of all cases. The sensitivity and specificity of CT were 99.4% and 80.0%, respectively. For US, the respective figures were 74.8 and 62.5%. CRP and LPC were significantly higher in the appendicitis group, compared to the non-appendicitis group. The negative appendectomy rate was slightly higher in the CT after US group i.e. 7.1% (3/42) compared to 4.67% (5/107) in the US group and 4.50% (7/155) in the CT group. Conclusions The diagnostic value of US and CT are both very high. The diagnostic value of clinical features and biochemistry alone is quite low. By combining radiological examination, clinical examination and laboratory values, low negative appendectomy rates can be achieved.

Levels and Trends of Maternal Mortality and Morbidity by Cause in North Africa and Middle East, 1990 to 2019: An Analysis for the Global Burden of Disease Study 2019.

Since 1990, the maternal mortality significantly decreased at global scale as well as the North Africa and Middle East. However, estimates for mortality and morbidity by cause and age at national scale in this region are not available. This study is part of the Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2019. Here we report maternal mortality and morbidity by age and cause across 21 countries in the region from 1990 to 2019. Between 1990 and 2019, maternal mortality ratio (MMR) dropped from 148.8 (129.6-171.2) to 94.3 (73.4-121.1) per 100000 live births in North Africa and Middle East. In 1990, MMR ranged from 6.0 (5.3-6.8) in Kuwait to 502.9 (375.2-655.3) per 100000 live births in Afghanistan. Respective figures for 2019 were 5.1 (4.0-6.4) in Kuwait to 269.9 (195.8-368.6) in Afghanistan. Percentages of deaths under 25 years was 26.0% in 1990 and 23.8% in 2019. Maternal hemorrhage, indirect maternal deaths, and other maternal disorders rank 1st to 3rd in the entire region. Ultimately, there was an evident decrease in MMR along with increase in socio-demographic index from 1990 to 2019 in all countries in the region and an evident convergence across nations. MMR has significantly declined in the region since 1990 and only five countries (Afghanistan, Sudan, Yemen, Morocco, and Algeria) out of 21 nations didn't achieve the Sustainable Development Goal (SDG) target of 70 deaths per 100000 live births in 2019. Despite the convergence in trends, there are still disparities across countries.

Teacher’s Professional Role In Improving The Learning Process

In this study, the author took the title The Professional Role of Teachers in Improving the Learning Process, for this we both know that the teacher is an important figure in an educational institution. His role as a teacher and educator makes him a highly respected figure for everyone. The professional role of teachers in improving the learning process is also inseparable from how much competence they have. The better the competencies he has, the better the learning process that takes place in the classroom. The position of the teacher as a professional is intended to function to increase the dignity and the role of the teacher as a learning agent to improve the quality of education and national education. The position of teachers as professionals aims to implement the national education system, namely the development of the potential of students to become human beings who believe and fear God Almighty, have noble character, are healthy, knowledgeable, capable, creative, independent, and become democratic and responsible citizens,answer.

Fire &amp; Ice: A Study of Contrasting Approaches to Football Management

Arsene Wenger stands today as one of the most respected figures in world football for a wide variety of factors. Standing for consistency and quality, his purpose was found in football management rather than an eight-year playing career in France included a league title with Strasbourg in 1978–79. His stature and credentials in the game is second to none reflected by the fact that he has been serving as FIFA’s chief of global football development following his retirement from management. His principles aided in building a persona and a brand which few could challenge, much less surpass. Born in France, in 1949, he is famous for having managed Arsenal F.C for 22 years which made the second longest serving a club after Sir Alex Ferguson. As his autobiography titled, “My life in Red and White”, Arsene Wenger had immense loyalty to his club perhaps an evidence of divine intervention that his name should sound so close to the place he called home for 22 years. Appropriately called ‘Le professeur’ by the media, which indicates the love and affection which came his way from the British media, which is arguably one of the most challenging in the entire sport of football. Perhaps it was a Masters degree in economics which earned him the respect but followers of the English premier league would attest to the fact that there have been fewer classy and sophisticated managers to have graced one of the oldest leagues in the world. As his autobiography reveals, Wenger brought in an era of scientific management to British football. It extended to scout in, play as training, and diet meticulously planned to ensure maximum performance, thereby bringing forth globalisation to the sport which was played with celebrating bad boys from the decades gone by. Wenger‘s penchant for developing young talents, emphasising on attacking football, relying on philosophy when most managers resorted to downright pragmatism through defensive football and most importantly, the ability to operate on a tight budget despite losing his talents to richer clubs are to be immensely appreciated. Wenger was unceremoniously kicked out from management with one year remaining on his contract following quite a strong narrative calling for his ouster owing to lack of trophies one in the last decade office management at Arsenal. This chapter dives into what management principles Arsenal had put into place with Wenger at the helm (Wenger 78). As Arsenal’s manager, Arsene Wenger was one of the longest serving managers in the EPL. He initially played football for amateur clubs and then went on to play for Strasbourg in the French league. In 1981, he completed his coaching qualifications and was appointed at Cannes, Nancy and later Monaco. Arsene Wengerwas recruited to Arsenal while coaching in Japan and arrived as a relatively unknown manager in 1996, bringing a scientific approach to training. During his time at Arsenal, the club won three EPL titles and seven Football Association (FA) Cups. In 2004, the team (nicknamed “The Invincibles”) was unbeaten throughout the season. Arsene Wengerleft Arsenal at the end of the 2017/2018 season (Berndt 34).

Temporal dynamics of Plasmodium falciparum population in Metehara, east-central Ethiopia

BackgroundPlasmodium falciparum is the most serious, genetically most complex and fastest-evolving malaria parasite. Information on genetic diversity of this parasite would guide policy decision and malaria elimination endeavors. This study explored the temporal dynamics of P. falciparum population in two time points in Metehara, east-central Ethiopia.MethodsThe participants were quantitative real-time polymerase chain reaction-confirmed patients who were recruited for uncomplicated falciparum malaria therapeutic efficacy test in 2015 and 2019. Dry blood spot samples were analysed by the nested PCR to genotype P. falciparum merozoite surface protein (msp1, msp2) and glutamate-rich protein (glurp) genes.ResultsWhile msp1, msp2 and glurp genotypes were successfully detected in 26(89.7%), 24(82.8%) and 14(48.3%) of 2015 samples (n = 29); the respective figures for 2019 (n = 41) were 31(68.3%), 39(95.1%), 25(61.0%). In 2015, the frequencies of K1, MAD20 and RO33 allelic families of msp1, and FC27 and IC/3D7 of msp2 were 19(73.1%), 8(30.6%), 14(53.8%), 21(87.5%), 12(50.5%); and in 2019 it was 15(48.4%), 19(61.3%), 15(48.4%), 30(76.9%), 27(69.2%) respectively. MAD20 has shown dominance over both K1 and RO33 in 2019 compared to the proportion in 2015. Similarly, although FC27 remained dominant, there was shifting trend in the frequency of IC/3D7 from 50.5% in 2015 to 69.2% in 2019. The multiplicity of infection (MOI) and expected heterozygosity index (He) in 2015 and 2019 were respectively [1.43 ± 0.84] and [1.15 ± 0.91], 0.3 and 0.03 for msp1. However, there was no significant association between MOI and age or parasitaemia in both time points.ConclusionThe lower genetic diversity in P. falciparum population in the two time points and overall declining trend as demonstrated by the lower MOI and He may suggest better progress in malaria control in Metehara. But, the driving force and selective advantage of switching to MAD20 dominance over the other two msp1 allelic families, and the dynamics within msp2 alleles needs further investigation.

Maternal Mortality and Morbidity by Cause in Provinces of Iran, 1990 to 2019: An Analysis for the Global Burden of Disease Study 2019.

Since 1990, maternal mortality ratio (MMR) has significantly decreased in Iran. However, estimates for mortality and morbidity by cause at subnational scale are not available. This study is part of the Global Burden of Diseases study (GBD) 2019. Here we report maternal mortality and morbidity by age and cause across 31 provinces of Iran from 1990 to 2019. Since 1990, MMR declined from 44.5 (95% UI: 38.6-50.1) to 15.9 (14.7-17.3) per 100000 live births in Iran. In 1990 MMR ranged from 18.5 (11.2-26.4) to 76.9 (38.4-114.7) per 100000 live births across provinces. Respective figures for 2019 were 7.1 (5.2-9.3) to 34.0 (25.1-44.7) per 100000 live births. In 2019, MMR was higher in young women (aged 10 to 14) and older women (aged 45 or more). Percentages of deaths under 25 years was 24.8% in 1990 and 16.0% in 2019. There was remarkable decline in years lost due to premature death (YLL) rates from 1990 to 2019. While the decline was modest for years lived with disability (YLD) rates. Indirect maternal deaths and other maternal deaths ranked first or second in almost all provinces. Ultimately, there was an evident decrease in MMR along with increase in socio-demographic Index (SDI) from 1990 to 2019 in all provinces and an evident convergence across provinces. MMR has declined to levels much lower than Sustainable Development Goals in all provinces. Although there was a convergence in trends, there are still disparities across provinces. The decline in disabilities caused by maternal disorders is not as significant as mortality, which needs further actions.

A Novel Tumor Staging System Incorporating Tumor Regression Grade (TRG) With Lymph Node Status (ypN-Category) Results in Better Prognostication Than ypTNM Stage Groups After Neoadjuvant Therapy for Esophageal Squamous Cell Carcinoma.

This study aims at constructing a staging system incorporating tumor regression grade and ypN-category (TRG-N) in patients with neoadjuvant therapy before esophagectomy. It is hypothesized that this would prognosticate better than the current American Joint Committee on Cancer (AJCC) postneoadjuvant therapy (ypTNM) stage groups. Conventional pathological T-category is defined by the depth of invasion, and may lose prognostic relevance after neoadjuvant therapy. TRG defines treatment response by the degree of tumor regression, and when combined with ypN-category may be more prognostic than AJCC postneoadjuvant therapy (ypTNM) stage groups. A training cohort of 210 patients with esophageal squamous cell carcinoma and who had had neoadjuvant therapy before esophagectomy were studied. A validation cohort comprised 107 patients from another hospital. Resected esophagi were assessed by ypT-category and TRG, the latter assigned according to the Becker 4-tier system. These categories were grouped with ypN-category into a TRG-N system. Patients' survival was compared between the current AJCC postneoadjuvant therapy (ypTNM) stage groups and this TRG-N system. In the training cohort, 5-year survival rates according to ypTNM stage I, II, IIIA, IIIB, and IVA were 53%, 39.4%, 47%, 18.3%, and 0%, respectively. For TRG-N stages I, II, III, and IV, the respective figures were 59.6%, 43.5%, 23.8%, and 15.6%. TRG-N stage showed better fit in survival than ypTNM stage groups, indicated by lower Akaike Information Criteria (AIC) and Bayesian Information Criterion values. Similar results were found in the validation cohort. Multivariate analysis showed that TRG-N stage ( P =0.02), age ( P =0.006), and sex ( P =0.005) were independent prognostic factors. TRG-N stage shows better prognostication than the AJCC postneoadjuvant therapy (ypTNM) stage groups.