The opioid epidemic in the United States continues to take the lives of many individuals, with overdoses continuing to rise every year. Naloxone is an opioid antagonist that is efficacious in temporarily reversing opi...The opioid epidemic in the United States continues to take the lives of many individuals, with overdoses continuing to rise every year. Naloxone is an opioid antagonist that is efficacious in temporarily reversing opioid overdoses. Pharmacists play an important role in the accessibility and education of naloxone in both the community and health system settings. Recent efforts, such as co-dispensing naloxone with opioid prescriptions, naloxone training programs, and approval of naloxone to be over-the-counter, have been implemented in hopes to better control the opioid epidemic. Despite the efforts to make naloxone more accessible, there are still some barriers to overcome such as lack of training, cost, stigma, and patient refusal. This review aims to explore the contributions pharmacists have made thus far and define the barriers that still have to be resolved.展开更多
BACKGROUND As a consequence of the economic crisis,the sociopolitical instability and the advent of the coronavirus disease-19 pandemic,nested challenges faced the Lebanese healthcare system.These have resulted in cri...BACKGROUND As a consequence of the economic crisis,the sociopolitical instability and the advent of the coronavirus disease-19 pandemic,nested challenges faced the Lebanese healthcare system.These have resulted in critical shortages of essential resources,including medications vital for oncologic patients.AIM To assess the ramifications of the ongoing economic crisis on oncology patient care focusing on our outpatient oncology department.METHODS A questionnaire was distributed during the month of February 2022 to oncology patients in Hôtel Dieu de France University Hospital in Beirut during their outpatient therapy.The primary objective was to assess the far-reaching impact of the economic crisis on patient care and the resulting psychological implications.RESULTS Among 182 interviewed patients,31.87%experienced treatment interruption mainly due to acute drug shortages.Despite 87.91%of the patients benefiting from third-party coverage,69.60%had to self-pay for their medications leading to 69.78%of patients perceiving that healthcare was more difficult to access after 2020.Psychologically,one-third of the patients exhibited symptoms of anxiety and/or depression,with 7 patients reporting suicidal ideations.Notably,37.93%of patients who interrupted cancer treatment reported a history of comorbidities,and 89.66%who altered their treatment cited financial difficulties.CONCLUSION Lebanese cancer patients face complex challenges spanning economic,healthcare,and psychological realms.Income inequalities exacerbated by the economic crisis hindered healthcare access.展开更多
The research proposal has the following scope. In relation to the general objective, the aim is to model the evolution of the climate crisis over time taking as variables global warming, greenhouse gases, atmospheric ...The research proposal has the following scope. In relation to the general objective, the aim is to model the evolution of the climate crisis over time taking as variables global warming, greenhouse gases, atmospheric temperature and ocean temperature, as well as the continuity of the natural phenomena in terms of their measurement, temporality and projection. To achieve the above, the description of the following specific objectives is proposed: - Identify the variables corresponding to the climate crisis, their relationship and correlation between them;- Develop projection models with mathematical and statistical arrangements to project them in a given time and, in this way, - Propose mitigation measures for different unfavorable scenarios. The main variables that are currently directly linked to Climate Change are: CO<sub>2</sub>, the atmospheric index, precipitation, temperature and wind speed. The correlation that exists between climatic elements is very high, both in historical behavior and projected behavior for 2035, their correlation is estimated at 0.90, 0.95, 0.93 and 91 respectively. The mathematical models used to manipulate the historical and projected analysis of the variables studied: are the normal arrangements, this ensures that the values can be used on a common scale;Then there is the analysis of the historical variables using the linear trend, and finally there is the analysis of the variables projected to the year 2035 using the polynomial trend. In both situations, the direct relationship of greenhouse gases, mainly CO<sub>2</sub>, is directly related to the variations of the variables over time, which is a very worrying result because we can no longer talk about climate change, but rather about CLIMATE CRISIS. To a large extent, a change in the paradigm of exploitation of the resources of our mother earth is required. Alert in an SOS manner to the great powers, which make reasonable use of technology, for this attenuation measures are proposed.展开更多
The article discusses the significance of the research,and outlines the concepts of psychological crisis,its intervention,and psychological crisis among college students,as well as relevant theories on psychological c...The article discusses the significance of the research,and outlines the concepts of psychological crisis,its intervention,and psychological crisis among college students,as well as relevant theories on psychological crisis.The research mainly adopts case study and interview methods.Through scientific analysis of psychological crisis cases in four grades of X College in ethnic regions,it summarizes the current situation of crisis psychology among X College students,hoping to provide some first-hand data and research ideas for relevant researchers.展开更多
This paper explores the Major National Dialogue organised by Paul Biya from the 30th of September to the 4th of October,2019 as a panacea to the Anglophone.The paper also seeks to find out if this dialogue has been th...This paper explores the Major National Dialogue organised by Paul Biya from the 30th of September to the 4th of October,2019 as a panacea to the Anglophone.The paper also seeks to find out if this dialogue has been the panacea Cameroonians as a whole and the people of Southern Cameroons in particular have been waiting for to end this conflict.This research uses a qualitative research design.This is because the researcher culled information from Jeune Afrique Economie(2019a),Cameroon Tribune,and from Phoenix.Descriptive analysis was used to analyse the collected data.Descriptive analysis is used to get the views of the public whether the Major National Dialogue was really a panacea to the Anglophone crisis.The analysis revealed that there were two opposing opinions on the holding of this dialogue.The government thinks the dialogue was a panacea to put an end to this crisis because there is ongoing construction work in the war zones,and economic activities have witnessed an increase in the regions as the various production units of the Cameroon Development Corporation(CDC)and Pamol plantations have regained agricultural activities.The Ndawara tea estate now functions without problems.Trans-border trade is on the rise and transportation is fluid,except in the rural areas where the state of the road network is poor to name but these.On the other hand,politicians,political parties like the Social Democratic Front,activists,religious leaders,the affected populations,and Cameroonians at large think that the Major National Dialogue was a monologue and therefore was bound to fail because first,key actors arrested and detained in connection to this crisis were not part of this dialogue.For this reason,they are calling for a genuine and an inclusive dialogue.In addition,they argue that we cannot be talking of peace when fighting is still raging on and people are being killed,houses and schools are being burnt,and people are being kidnapped every day for ransom to mention but these.展开更多
Financial crisis prediction(FCP)received significant attention in the financial sector for decision-making.Proper forecasting of the number of firms possible to fail is important to determine the growth index and stre...Financial crisis prediction(FCP)received significant attention in the financial sector for decision-making.Proper forecasting of the number of firms possible to fail is important to determine the growth index and strength of a nation’s economy.Conventionally,numerous approaches have been developed in the design of accurate FCP processes.At the same time,classifier efficacy and predictive accuracy are inadequate for real-time applications.In addition,several established techniques carry out well to any of the specific datasets but are not adjustable to distinct datasets.Thus,there is a necessity for developing an effectual prediction technique for optimum classifier performance and adjustable to various datasets.This paper presents a novel multi-vs.optimization(MVO)based feature selection(FS)with an optimal variational auto encoder(OVAE)model for FCP.The proposed multi-vs.optimization based feature selection with optimal variational auto encoder(MVOFS-OVAE)model mainly aims to accomplish forecasting the financial crisis.For achieving this,the proposed MVOFS-OVAE model primarily pre-processes the financial data using min-max normalization.In addition,the MVOFS-OVAE model designs a feature subset selection process using the MVOFS approach.Followed by,the variational auto encoder(VAE)model is applied for the categorization of financial data into financial crisis or non-financial crisis.Finally,the differential evolution(DE)algorithm is utilized for the parameter tuning of the VAE model.A series of simulations on the benchmark dataset reported the betterment of the MVOFS-OVAE approach over the recent state of art approaches.展开更多
Introduction Acute angle closure crisis (AACC) is a major ophthalmic emergency. It is a sight-threatening pathology that is very common in women but rarely described in melanodermas. The aim of this work is to investi...Introduction Acute angle closure crisis (AACC) is a major ophthalmic emergency. It is a sight-threatening pathology that is very common in women but rarely described in melanodermas. The aim of this work is to investigate the epidemiological and clinical aspects of acute angle closure crisis. Results We collected 24 patient records, totaling 25 eyes. The average age of our patients was 52.04 years, with a male-to-female ratio of 0.6. A family history of glaucoma occurred in 34% of patients. Patients consulted for a painful red eye associated or not with decreased visual acuity (DVA). The condition was bilateral in one patient. The average visual acuity wax 0.34/10<sup>e</sup>. The cornea was cloudy and the pupil in areflexic mydriasis in all sick eyes. Hypothalamia was present in 72% of eyes and cataracts in 54.16% of cases. The average intraocular press was 44.38 mmHg and the average cup/disc (C/D) was 0.46. Gonioscopy was performed in 7 patients. The fellow eye did not present any abnormalities in 92% of cases. Conclusion The acute angle closure crisis is a rare condition in melanodermas and common in woman. His diagnostic is essentially clinical and completed by gonioscopy which plays a fundamental role. .展开更多
In recent decades,Haiti has been subject to man-made and natural disasters that have left its citizens vulnerable to a range of shocks.With a weak state unable to protect its populace,Haitians are exposed to some of t...In recent decades,Haiti has been subject to man-made and natural disasters that have left its citizens vulnerable to a range of shocks.With a weak state unable to protect its populace,Haitians are exposed to some of the highest levels of poverty and violence in the Western Hemisphere.In recent years,Haitians have experienced two crises that this study analyzes:the instability and political violence of“peyi lòk”as well as the global pandemic of COVID-19.This community-based assessment explores the impact of these two crises on the mental health and psychological well-being of 38 Haitian university students in the understudied northern part of the country.Results indicate that both crises had similarities related to their psychological effects on young people,most notably in terms of traumatic experiences related to threats or violence,forced confinement,and large increases in population-wide uncertainty.Additionally,the extreme violence of“peyi lòk”and the widespread unpredictability of COVID-19 and its effects in the early days of the pandemic resulted in high levels of stress and fear.Both crises also resulted in extreme economic hardship for students,with many reporting difficulties accessing basic needs such as food and water.This study highlights how converging population-level crises in“complex emergencies”can heighten trauma and compromise mental health.展开更多
This study aims to examine the time-varying efficiency of the Turkish stock market’s major stock index and eight sectoral indices,including the industrial,financial,service,information technology,basic metals,tourism...This study aims to examine the time-varying efficiency of the Turkish stock market’s major stock index and eight sectoral indices,including the industrial,financial,service,information technology,basic metals,tourism,real estate investment,and chemical petrol plastic,during the COVID-19 outbreak and the global financial crisis(GFC)within the framework of the adaptive market hypothesis.This study employs multifractal detrended fluctuation analysis to illustrate these sectors’multifractality and short-and long-term dependence.The results show that all sectoral returns have greater persis-tence during the COVID-19 outbreak than during the GFC.Second,the real estate and information technology industries had the lowest levels of efficiency during the GFC and the COVID-19 outbreak.Lastly,the fat-tailed distribution has a greater effect on multifractality in these industries.Our results validate the conclusions of the adaptive market hypothesis,according to which arbitrage opportunities vary over time,and contribute to policy formulation for future outbreak-induced economic crises.展开更多
Tetralogy of Fallot(TOF)with total anomalous pulmonary vein connections(TAPVC)is a rare type of complex congenital heart disease among all TOF cases.Co-presentation of major aortopulmonary collateral arteries(MAPCAs)c...Tetralogy of Fallot(TOF)with total anomalous pulmonary vein connections(TAPVC)is a rare type of complex congenital heart disease among all TOF cases.Co-presentation of major aortopulmonary collateral arteries(MAPCAs)compensates for the lack of central pulmonary bloodflow and decreases the severity of right-to-left shunting in TOF.We present a case of a 2-year-old child with complex diagnoses of TOF,TAPVC,a large secun-dum atrial septal defect(ASD),and intraoperatively identified MAPCAs.She underwent surgery to repair the TAPVC,valve-sparing reconstruction of the right ventricular outflow tract,interventricular defect closure,and the creation of patent foramen ovale(PFO).After the operation,hemodynamic instability happened along with sudden blood pressure drop,desaturation,and increased central venous pressure,which subsided after adminis-tering inhalational nitric oxide(NO).A postoperative pulmonary hypertension crisis was suggested when the patient experienced recurrent symptoms after the termination of NO.Echocardiographicfindings of a D-shaped left ventricle(LV),right-to-left PFO shunt and high tricuspid valve gradientfirmly established the diagnosis.It was subsequently managed with continuous NO inhalation and sildenafil,which rendered a satisfactory outcome.Repaired TOF and TAPVC could be at particular risk of developing pulmonary hypertension crisis,especially in the presence of MAPCAs due to possible remodeling of the pulmonary vasculature.Furthermore,a relatively non-compliant LV function and small left atrial size may exacerbate the risk of developing postcapillary pulmonary hypertension after TAPVC repair.A successful postoperative outcome calls for a meticulous preoperative analysis of the anatomical lesions,as well as careful monitoring.展开更多
BACKGROUND Myelodysplastic syndrome(MDS)is caused by malignant proliferation and ineffective hematopoiesis.Oncogenic somatic mutations and increased apoptosis,necroptosis and pyroptosis lead to the accumulation of ear...BACKGROUND Myelodysplastic syndrome(MDS)is caused by malignant proliferation and ineffective hematopoiesis.Oncogenic somatic mutations and increased apoptosis,necroptosis and pyroptosis lead to the accumulation of earlier hematopoietic progenitors and impaired productivity of mature blood cells.An increased percentage of myeloblasts and the presence of unfavorable somatic mutations are signs of leukemic hematopoiesis and indicators of entrance into an advanced stage.Bone marrow cellularity and myeloblasts usually increase with disease progression.However,aplastic crisis occasionally occurs in advanced MDS.CASE SUMMARY A 72-year-old male patient was definitively diagnosed with MDS with excess blasts-1(MDS-EB-1)based on an increase in the percentages of myeloblasts and cluster of differentiation(CD)34+hematopoietic progenitors and the identification of myeloid neoplasm-associated somatic mutations in bone marrow samples.The patient was treated with hypomethylation therapy and was able to maintain a steady disease state for 2 years.In the treatment process,the advanced MDS patient experienced an episode of progressive pancytopenia and bone marrow aplasia.During the aplastic crisis,the bone marrow was infiltrated with sparsely distributed atypical lymphocytes.Surprisingly,the leukemic cells disappeared.Immunological analysis revealed that the atypical lymphocytes expressed a high frequency of CD3,CD5,CD8,CD16,CD56 and CD57,suggesting the activation of autoimmune cytotoxic T-lymphocytes and natural killer(NK)/NKT cells that suppressed both normal and leukemic hematopoiesis.Elevated serum levels of inflammatory cytokines,including interleukin(IL)-6,interferon-gamma(IFN-γ)and tumor necrosis factor-alpha(TNF-α),confirmed the deranged type I immune responses.This morphological and immunological signature led to the diagnosis of severe aplastic anemia secondary to large granule lymphocyte leukemia.Disseminated tuberculosis was suspected upon radiological examinations in the search for an inflammatory niche.Antituberculosis treatment led to reversion of the aplastic crisis,disappearance of the atypical lymphocytes,increased marrow cellularity and 2 mo of hematological remission,providing strong evidence that disseminated tuberculosis was responsible for the development of the aplastic crisis,the regression of leukemic cells and the activation of CD56+atypical lymphocytes.Reinstitution of hypomethylation therapy in the following 19 mo allowed the patient to maintain a steady disease state.However,the patient transformed the disease phenotype into acute myeloid leukemia and eventually died of disease progression and an overwhelming infectious episode.CONCLUSION Disseminated tuberculosis can induce CD56+lymphocyte infiltration in the bone marrow and in turn suppress both normal and leukemic hematopoiesis,resulting in the development of aplastic crisis and leukemic cell regression.展开更多
The Taiwan Question China discussed in this paper belongs to the theoretical crisis discussion on international relations and does not regard the Cross-Strait relations as relations between different countries.The out...The Taiwan Question China discussed in this paper belongs to the theoretical crisis discussion on international relations and does not regard the Cross-Strait relations as relations between different countries.The outcome of the 2024 Taiwan Election has a great impact on the Taiwan question,the latest poll shows that the possibility of the Democratic Progressive Party(DPP)candidate to come to power is still very high,because its political evolution trend of Taiwan independence still exists.展开更多
Since the beginning of the 21st century,various crisis events have occurred frequently,inflicting substantial impacts on the tourism sector,which has garnered considerable scholarly and policy attention.Nevertheless,l...Since the beginning of the 21st century,various crisis events have occurred frequently,inflicting substantial impacts on the tourism sector,which has garnered considerable scholarly and policy attention.Nevertheless,limited research has systematically explored tourism resilience at the urban scale,and there is a paucity of studies comparing regional differences in tourism resilience under distinct crisis scenarios and their underlying causes.Thus,this study focuses on the Yangtze River Delta and the Pearl River Delta,employing Martin’s regional economic resilience measurement method.It assesses the tourism resilience of the two regions under the impact of the 2008 financial crisis and the COVID-19 pandemic,subsequently visualizing the data results using ArcGIS software.The study also endeavors to unveil potential causes for disparities in urban tourism resilience.The main conclusions are as follows:Firstly,regions with higher economic development exhibit relatively weaker tourism resilience during economic crises,yet demonstrate comparatively stronger resilience during public crises.Secondly,distinct differentiations exist both between and within the Yangtze River Delta and the Pearl River Delta,primarily stemming from variations such as geographical positioning,tourism resource endowments,and industrial and economic structures,both regionally and within individual cities.Thirdly,the determination of regional tourism resilience is intricate and cannot be restricted to a single dimension;multidimensional indicators better encapsulate the essence of regional tourism resilience.展开更多
This exploratory study examines the phenomenon of consequence cause matching,which is based on the representativeness heuristic,from cognitive psychology,upon crisis management and public relations.A 2(Large Scale Cri...This exploratory study examines the phenomenon of consequence cause matching,which is based on the representativeness heuristic,from cognitive psychology,upon crisis management and public relations.A 2(Large Scale Crisis vs.Small Scale Crisis)×2(Large Scale Cause vs.Small Scale Cause)mixed factorial design experiment was conducted based upon a hypothetical crisis scenario.This study found initial evidence that consequence cause matching is a phenomenon that can impact the process of attribution for a crisis.It highlights a potential new area of theoretical growth for the situational crisis communication theory.展开更多
In Sunset Park,the contemporary American writer Paul Auster reveals the political,economic and social problems that have surfaced in America in the wake of the 9/11 incident.Focusing on the image of people on the edge...In Sunset Park,the contemporary American writer Paul Auster reveals the political,economic and social problems that have surfaced in America in the wake of the 9/11 incident.Focusing on the image of people on the edge of the city,the author describes how they rebuild their lives after illegally living in an abandoned apartment in Sunset Park,using the art and the community as a spiritual refuge to seek comfort and heal wounds,reconstruct self-identity,and fight against the unfair society.This article analyzes the characteristics of the community in the novel Sunset Park,to interpret its functions,and to show the healing power of a caring community.展开更多
BACKGROUND Extramedullary blast crisis in chronic myeloid leukemia(CML)is an uncommon occurrence of leukemic blast infiltration in regions other than the bone marrow.Malignant infiltration of the serosal membranes sho...BACKGROUND Extramedullary blast crisis in chronic myeloid leukemia(CML)is an uncommon occurrence of leukemic blast infiltration in regions other than the bone marrow.Malignant infiltration of the serosal membranes should be considered in cases where CML presents with ascites or pleural effusion.CASE SUMMARY A 23-year-old female with CML presented with progressively worsening ascites and pleural effusion despite first-line tyrosine kinase inhibitor treatment.Her blood work indicated leukocytosis with myelocyte bulge and 2%blasts.Analysis of the patient’s bone marrow confirmed the chronic phase of CML.Abdominal ultrasound revealed hepatosplenomegaly with ascites.The fluid investigation of both ascites and pleural effusion revealed a predominance of neutrophils with exudate.However,no acid-fast bacilli or growth was observed after culturing.Although hydroxyurea reduced cell counts,there was no observed effect on ascites or pleural effusion.Repeat investigation of the ascitic and pleural fluid revealed a polymorphous myeloid cell population consisting of myelocytes,metamyelocytes,band forms,neutrophils and a few myeloblasts.Extramedullary blast crisis was suspected,and mutation analysis was performed.We switched the patient to dasatinib.The patient’s symptoms were relieved,and ascites and pleural effusion diminished.CONCLUSION Serosal membrane involvement in CML is extremely rare.In this case,the patient responded well to dasatinib treatment.展开更多
Objective To describe the impact of the global economic crisis on the nutritional status of children in China during and after the crisis.Methods Data from 1990 to 2010 were sourced from the National Food and Nutritio...Objective To describe the impact of the global economic crisis on the nutritional status of children in China during and after the crisis.Methods Data from 1990 to 2010 were sourced from the National Food and Nutrition Surveillance System.Approximately 16 000 children under 5 years old were selected using a stratified random cluster method from 40 surveillance sites.Anthropometric and hemoglobin measurements for children under 5 were conducted.Nutritional status was determined according to WHO child growth standards.Results Prevalence of underweight and stunting in children under 5 had a downward trend.Underweight prevalence was close to normal (less than 5%),with prevalence of stunting 12.6% in 2009 and 12.1% in 2010 in rural areas.Prevalence of stunting in infants under 6 months and 6‐12 months old in poorer rural areas increased from 5.7%‐9.1% and 6.7%‐12.5%,respectively,in 2008‐2009.This trend also continued post‐crisis in 2010.Prevalence of stunting in children left behind by mothers was 20%‐30% higher than in children the same age in general and poorer rural areas.Prevalence of anemia in children did not change in rural areas,but prevalence of anemia in all age groups increased in poorer rural areas,especially in children under 24 months old.Level reached 30%‐40% in 2009,and fluctuated in 2010.Conclusion The nutritional status of children under 5 was comparatively stable during and after the global economic crisis,attributable to the Chinese government's policy response.The nutritional status in poorer rural areas fluctuated in response to the economic crisis and,thus,relevant action and intervention must be taken immediately to help the most vulnerable population in poorer rural areas.A proper national nutritional strategy for children under 2 years old,including nutrition supplementation for pregnant women and in‐home fortification for complementary feeding,should be initiated.展开更多
In order to explore the changes and the roles of TXA2 and PGI2 during postoperative hypertensive crisis in patients with hypertensive intracerebral hemorrhage, 31 cases subject to craniotomy were divided into three gr...In order to explore the changes and the roles of TXA2 and PGI2 during postoperative hypertensive crisis in patients with hypertensive intracerebral hemorrhage, 31 cases subject to craniotomy were divided into three groups: group A, 9 patients with postoperative hypertensive crisis; group B, 13 patients without postoperative hypertensive crisis; and group C, 9 patients without history of hypertension and hypertensive intracerebral hemorrhage. TXA2, TXB2, 6-keto-PGF1α and PGI2 were measured after operation in the three groups respectively. The postoperative blood pressure in group A, including SBP and DBP, was elevated more obviously than that in the other two groups. TXA2 and PGI2 in group A were significantly higher than those in other two groups (P〈0.01). Moreover, the ratio of TXB2 to 6-keto-PGF1α in group A was significantly higher than that in other two groups (P〈0.05). The increase of TXA2 and the relative inadequacy of prostacyclin, especially 6-keto-PGF1α, may play roles in the postoperative hypertensive crisis. And the increased value of TXB2 to 6-keto-PGF1α could provide the basis for diagnosis of postoperative hypertensive crisis.展开更多
In order to study the entrepreneurship situation of Jiangxi return migrant workers after the financial crisis,we have conducted a survey on 107 entrepreneurial return migrant workers in 6 counties of Jiangxi Province....In order to study the entrepreneurship situation of Jiangxi return migrant workers after the financial crisis,we have conducted a survey on 107 entrepreneurial return migrant workers in 6 counties of Jiangxi Province.The results show that the return of migrant workers is mainly attributed to personal factors,while social factors are also very important.The major difficulties facing return migrant workers are the funding difficulties,complicated formalities to start a business,difficulty in safeguarding their rights and interests,their own low quality and so on.The support needed by the return migrant workers from the government is manifested in five aspects,say,to improve the service and management for the entrepreneurship of migrant workers,to provide financing policy support,to increase the preferential fiscal and taxation policies,to enhance the entrepreneurship training and to provide preference for the return migrant workers to use land.展开更多
文摘The opioid epidemic in the United States continues to take the lives of many individuals, with overdoses continuing to rise every year. Naloxone is an opioid antagonist that is efficacious in temporarily reversing opioid overdoses. Pharmacists play an important role in the accessibility and education of naloxone in both the community and health system settings. Recent efforts, such as co-dispensing naloxone with opioid prescriptions, naloxone training programs, and approval of naloxone to be over-the-counter, have been implemented in hopes to better control the opioid epidemic. Despite the efforts to make naloxone more accessible, there are still some barriers to overcome such as lack of training, cost, stigma, and patient refusal. This review aims to explore the contributions pharmacists have made thus far and define the barriers that still have to be resolved.
文摘BACKGROUND As a consequence of the economic crisis,the sociopolitical instability and the advent of the coronavirus disease-19 pandemic,nested challenges faced the Lebanese healthcare system.These have resulted in critical shortages of essential resources,including medications vital for oncologic patients.AIM To assess the ramifications of the ongoing economic crisis on oncology patient care focusing on our outpatient oncology department.METHODS A questionnaire was distributed during the month of February 2022 to oncology patients in Hôtel Dieu de France University Hospital in Beirut during their outpatient therapy.The primary objective was to assess the far-reaching impact of the economic crisis on patient care and the resulting psychological implications.RESULTS Among 182 interviewed patients,31.87%experienced treatment interruption mainly due to acute drug shortages.Despite 87.91%of the patients benefiting from third-party coverage,69.60%had to self-pay for their medications leading to 69.78%of patients perceiving that healthcare was more difficult to access after 2020.Psychologically,one-third of the patients exhibited symptoms of anxiety and/or depression,with 7 patients reporting suicidal ideations.Notably,37.93%of patients who interrupted cancer treatment reported a history of comorbidities,and 89.66%who altered their treatment cited financial difficulties.CONCLUSION Lebanese cancer patients face complex challenges spanning economic,healthcare,and psychological realms.Income inequalities exacerbated by the economic crisis hindered healthcare access.
文摘The research proposal has the following scope. In relation to the general objective, the aim is to model the evolution of the climate crisis over time taking as variables global warming, greenhouse gases, atmospheric temperature and ocean temperature, as well as the continuity of the natural phenomena in terms of their measurement, temporality and projection. To achieve the above, the description of the following specific objectives is proposed: - Identify the variables corresponding to the climate crisis, their relationship and correlation between them;- Develop projection models with mathematical and statistical arrangements to project them in a given time and, in this way, - Propose mitigation measures for different unfavorable scenarios. The main variables that are currently directly linked to Climate Change are: CO<sub>2</sub>, the atmospheric index, precipitation, temperature and wind speed. The correlation that exists between climatic elements is very high, both in historical behavior and projected behavior for 2035, their correlation is estimated at 0.90, 0.95, 0.93 and 91 respectively. The mathematical models used to manipulate the historical and projected analysis of the variables studied: are the normal arrangements, this ensures that the values can be used on a common scale;Then there is the analysis of the historical variables using the linear trend, and finally there is the analysis of the variables projected to the year 2035 using the polynomial trend. In both situations, the direct relationship of greenhouse gases, mainly CO<sub>2</sub>, is directly related to the variations of the variables over time, which is a very worrying result because we can no longer talk about climate change, but rather about CLIMATE CRISIS. To a large extent, a change in the paradigm of exploitation of the resources of our mother earth is required. Alert in an SOS manner to the great powers, which make reasonable use of technology, for this attenuation measures are proposed.
基金Self-funded project“Research on Intervention Pathways for Psychological Crisis of College Students in Ethnic Regions”by Sichuan Minzu College(Project number:XYZB2328SB)。
文摘The article discusses the significance of the research,and outlines the concepts of psychological crisis,its intervention,and psychological crisis among college students,as well as relevant theories on psychological crisis.The research mainly adopts case study and interview methods.Through scientific analysis of psychological crisis cases in four grades of X College in ethnic regions,it summarizes the current situation of crisis psychology among X College students,hoping to provide some first-hand data and research ideas for relevant researchers.
文摘This paper explores the Major National Dialogue organised by Paul Biya from the 30th of September to the 4th of October,2019 as a panacea to the Anglophone.The paper also seeks to find out if this dialogue has been the panacea Cameroonians as a whole and the people of Southern Cameroons in particular have been waiting for to end this conflict.This research uses a qualitative research design.This is because the researcher culled information from Jeune Afrique Economie(2019a),Cameroon Tribune,and from Phoenix.Descriptive analysis was used to analyse the collected data.Descriptive analysis is used to get the views of the public whether the Major National Dialogue was really a panacea to the Anglophone crisis.The analysis revealed that there were two opposing opinions on the holding of this dialogue.The government thinks the dialogue was a panacea to put an end to this crisis because there is ongoing construction work in the war zones,and economic activities have witnessed an increase in the regions as the various production units of the Cameroon Development Corporation(CDC)and Pamol plantations have regained agricultural activities.The Ndawara tea estate now functions without problems.Trans-border trade is on the rise and transportation is fluid,except in the rural areas where the state of the road network is poor to name but these.On the other hand,politicians,political parties like the Social Democratic Front,activists,religious leaders,the affected populations,and Cameroonians at large think that the Major National Dialogue was a monologue and therefore was bound to fail because first,key actors arrested and detained in connection to this crisis were not part of this dialogue.For this reason,they are calling for a genuine and an inclusive dialogue.In addition,they argue that we cannot be talking of peace when fighting is still raging on and people are being killed,houses and schools are being burnt,and people are being kidnapped every day for ransom to mention but these.
文摘Financial crisis prediction(FCP)received significant attention in the financial sector for decision-making.Proper forecasting of the number of firms possible to fail is important to determine the growth index and strength of a nation’s economy.Conventionally,numerous approaches have been developed in the design of accurate FCP processes.At the same time,classifier efficacy and predictive accuracy are inadequate for real-time applications.In addition,several established techniques carry out well to any of the specific datasets but are not adjustable to distinct datasets.Thus,there is a necessity for developing an effectual prediction technique for optimum classifier performance and adjustable to various datasets.This paper presents a novel multi-vs.optimization(MVO)based feature selection(FS)with an optimal variational auto encoder(OVAE)model for FCP.The proposed multi-vs.optimization based feature selection with optimal variational auto encoder(MVOFS-OVAE)model mainly aims to accomplish forecasting the financial crisis.For achieving this,the proposed MVOFS-OVAE model primarily pre-processes the financial data using min-max normalization.In addition,the MVOFS-OVAE model designs a feature subset selection process using the MVOFS approach.Followed by,the variational auto encoder(VAE)model is applied for the categorization of financial data into financial crisis or non-financial crisis.Finally,the differential evolution(DE)algorithm is utilized for the parameter tuning of the VAE model.A series of simulations on the benchmark dataset reported the betterment of the MVOFS-OVAE approach over the recent state of art approaches.
文摘Introduction Acute angle closure crisis (AACC) is a major ophthalmic emergency. It is a sight-threatening pathology that is very common in women but rarely described in melanodermas. The aim of this work is to investigate the epidemiological and clinical aspects of acute angle closure crisis. Results We collected 24 patient records, totaling 25 eyes. The average age of our patients was 52.04 years, with a male-to-female ratio of 0.6. A family history of glaucoma occurred in 34% of patients. Patients consulted for a painful red eye associated or not with decreased visual acuity (DVA). The condition was bilateral in one patient. The average visual acuity wax 0.34/10<sup>e</sup>. The cornea was cloudy and the pupil in areflexic mydriasis in all sick eyes. Hypothalamia was present in 72% of eyes and cataracts in 54.16% of cases. The average intraocular press was 44.38 mmHg and the average cup/disc (C/D) was 0.46. Gonioscopy was performed in 7 patients. The fellow eye did not present any abnormalities in 92% of cases. Conclusion The acute angle closure crisis is a rare condition in melanodermas and common in woman. His diagnostic is essentially clinical and completed by gonioscopy which plays a fundamental role. .
文摘In recent decades,Haiti has been subject to man-made and natural disasters that have left its citizens vulnerable to a range of shocks.With a weak state unable to protect its populace,Haitians are exposed to some of the highest levels of poverty and violence in the Western Hemisphere.In recent years,Haitians have experienced two crises that this study analyzes:the instability and political violence of“peyi lòk”as well as the global pandemic of COVID-19.This community-based assessment explores the impact of these two crises on the mental health and psychological well-being of 38 Haitian university students in the understudied northern part of the country.Results indicate that both crises had similarities related to their psychological effects on young people,most notably in terms of traumatic experiences related to threats or violence,forced confinement,and large increases in population-wide uncertainty.Additionally,the extreme violence of“peyi lòk”and the widespread unpredictability of COVID-19 and its effects in the early days of the pandemic resulted in high levels of stress and fear.Both crises also resulted in extreme economic hardship for students,with many reporting difficulties accessing basic needs such as food and water.This study highlights how converging population-level crises in“complex emergencies”can heighten trauma and compromise mental health.
文摘This study aims to examine the time-varying efficiency of the Turkish stock market’s major stock index and eight sectoral indices,including the industrial,financial,service,information technology,basic metals,tourism,real estate investment,and chemical petrol plastic,during the COVID-19 outbreak and the global financial crisis(GFC)within the framework of the adaptive market hypothesis.This study employs multifractal detrended fluctuation analysis to illustrate these sectors’multifractality and short-and long-term dependence.The results show that all sectoral returns have greater persis-tence during the COVID-19 outbreak than during the GFC.Second,the real estate and information technology industries had the lowest levels of efficiency during the GFC and the COVID-19 outbreak.Lastly,the fat-tailed distribution has a greater effect on multifractality in these industries.Our results validate the conclusions of the adaptive market hypothesis,according to which arbitrage opportunities vary over time,and contribute to policy formulation for future outbreak-induced economic crises.
基金The report was conducted in accordance with the Nuremberg Code and Declaration of Helsinki,and the protocol was approved by the Institutional Review Board of National Cardiovascular Center Harapan Kita(No.LB.02.01/VII/037/KEP037/2022).
文摘Tetralogy of Fallot(TOF)with total anomalous pulmonary vein connections(TAPVC)is a rare type of complex congenital heart disease among all TOF cases.Co-presentation of major aortopulmonary collateral arteries(MAPCAs)compensates for the lack of central pulmonary bloodflow and decreases the severity of right-to-left shunting in TOF.We present a case of a 2-year-old child with complex diagnoses of TOF,TAPVC,a large secun-dum atrial septal defect(ASD),and intraoperatively identified MAPCAs.She underwent surgery to repair the TAPVC,valve-sparing reconstruction of the right ventricular outflow tract,interventricular defect closure,and the creation of patent foramen ovale(PFO).After the operation,hemodynamic instability happened along with sudden blood pressure drop,desaturation,and increased central venous pressure,which subsided after adminis-tering inhalational nitric oxide(NO).A postoperative pulmonary hypertension crisis was suggested when the patient experienced recurrent symptoms after the termination of NO.Echocardiographicfindings of a D-shaped left ventricle(LV),right-to-left PFO shunt and high tricuspid valve gradientfirmly established the diagnosis.It was subsequently managed with continuous NO inhalation and sildenafil,which rendered a satisfactory outcome.Repaired TOF and TAPVC could be at particular risk of developing pulmonary hypertension crisis,especially in the presence of MAPCAs due to possible remodeling of the pulmonary vasculature.Furthermore,a relatively non-compliant LV function and small left atrial size may exacerbate the risk of developing postcapillary pulmonary hypertension after TAPVC repair.A successful postoperative outcome calls for a meticulous preoperative analysis of the anatomical lesions,as well as careful monitoring.
基金Supported by The Specialized Scientific Research Fund Projects of The Medical Group of Qingdao University,No.YLJT20201002.
文摘BACKGROUND Myelodysplastic syndrome(MDS)is caused by malignant proliferation and ineffective hematopoiesis.Oncogenic somatic mutations and increased apoptosis,necroptosis and pyroptosis lead to the accumulation of earlier hematopoietic progenitors and impaired productivity of mature blood cells.An increased percentage of myeloblasts and the presence of unfavorable somatic mutations are signs of leukemic hematopoiesis and indicators of entrance into an advanced stage.Bone marrow cellularity and myeloblasts usually increase with disease progression.However,aplastic crisis occasionally occurs in advanced MDS.CASE SUMMARY A 72-year-old male patient was definitively diagnosed with MDS with excess blasts-1(MDS-EB-1)based on an increase in the percentages of myeloblasts and cluster of differentiation(CD)34+hematopoietic progenitors and the identification of myeloid neoplasm-associated somatic mutations in bone marrow samples.The patient was treated with hypomethylation therapy and was able to maintain a steady disease state for 2 years.In the treatment process,the advanced MDS patient experienced an episode of progressive pancytopenia and bone marrow aplasia.During the aplastic crisis,the bone marrow was infiltrated with sparsely distributed atypical lymphocytes.Surprisingly,the leukemic cells disappeared.Immunological analysis revealed that the atypical lymphocytes expressed a high frequency of CD3,CD5,CD8,CD16,CD56 and CD57,suggesting the activation of autoimmune cytotoxic T-lymphocytes and natural killer(NK)/NKT cells that suppressed both normal and leukemic hematopoiesis.Elevated serum levels of inflammatory cytokines,including interleukin(IL)-6,interferon-gamma(IFN-γ)and tumor necrosis factor-alpha(TNF-α),confirmed the deranged type I immune responses.This morphological and immunological signature led to the diagnosis of severe aplastic anemia secondary to large granule lymphocyte leukemia.Disseminated tuberculosis was suspected upon radiological examinations in the search for an inflammatory niche.Antituberculosis treatment led to reversion of the aplastic crisis,disappearance of the atypical lymphocytes,increased marrow cellularity and 2 mo of hematological remission,providing strong evidence that disseminated tuberculosis was responsible for the development of the aplastic crisis,the regression of leukemic cells and the activation of CD56+atypical lymphocytes.Reinstitution of hypomethylation therapy in the following 19 mo allowed the patient to maintain a steady disease state.However,the patient transformed the disease phenotype into acute myeloid leukemia and eventually died of disease progression and an overwhelming infectious episode.CONCLUSION Disseminated tuberculosis can induce CD56+lymphocyte infiltration in the bone marrow and in turn suppress both normal and leukemic hematopoiesis,resulting in the development of aplastic crisis and leukemic cell regression.
文摘The Taiwan Question China discussed in this paper belongs to the theoretical crisis discussion on international relations and does not regard the Cross-Strait relations as relations between different countries.The outcome of the 2024 Taiwan Election has a great impact on the Taiwan question,the latest poll shows that the possibility of the Democratic Progressive Party(DPP)candidate to come to power is still very high,because its political evolution trend of Taiwan independence still exists.
基金funded by National Natural Science Foundation of China,grant number 42271182.
文摘Since the beginning of the 21st century,various crisis events have occurred frequently,inflicting substantial impacts on the tourism sector,which has garnered considerable scholarly and policy attention.Nevertheless,limited research has systematically explored tourism resilience at the urban scale,and there is a paucity of studies comparing regional differences in tourism resilience under distinct crisis scenarios and their underlying causes.Thus,this study focuses on the Yangtze River Delta and the Pearl River Delta,employing Martin’s regional economic resilience measurement method.It assesses the tourism resilience of the two regions under the impact of the 2008 financial crisis and the COVID-19 pandemic,subsequently visualizing the data results using ArcGIS software.The study also endeavors to unveil potential causes for disparities in urban tourism resilience.The main conclusions are as follows:Firstly,regions with higher economic development exhibit relatively weaker tourism resilience during economic crises,yet demonstrate comparatively stronger resilience during public crises.Secondly,distinct differentiations exist both between and within the Yangtze River Delta and the Pearl River Delta,primarily stemming from variations such as geographical positioning,tourism resource endowments,and industrial and economic structures,both regionally and within individual cities.Thirdly,the determination of regional tourism resilience is intricate and cannot be restricted to a single dimension;multidimensional indicators better encapsulate the essence of regional tourism resilience.
文摘This exploratory study examines the phenomenon of consequence cause matching,which is based on the representativeness heuristic,from cognitive psychology,upon crisis management and public relations.A 2(Large Scale Crisis vs.Small Scale Crisis)×2(Large Scale Cause vs.Small Scale Cause)mixed factorial design experiment was conducted based upon a hypothetical crisis scenario.This study found initial evidence that consequence cause matching is a phenomenon that can impact the process of attribution for a crisis.It highlights a potential new area of theoretical growth for the situational crisis communication theory.
文摘In Sunset Park,the contemporary American writer Paul Auster reveals the political,economic and social problems that have surfaced in America in the wake of the 9/11 incident.Focusing on the image of people on the edge of the city,the author describes how they rebuild their lives after illegally living in an abandoned apartment in Sunset Park,using the art and the community as a spiritual refuge to seek comfort and heal wounds,reconstruct self-identity,and fight against the unfair society.This article analyzes the characteristics of the community in the novel Sunset Park,to interpret its functions,and to show the healing power of a caring community.
文摘BACKGROUND Extramedullary blast crisis in chronic myeloid leukemia(CML)is an uncommon occurrence of leukemic blast infiltration in regions other than the bone marrow.Malignant infiltration of the serosal membranes should be considered in cases where CML presents with ascites or pleural effusion.CASE SUMMARY A 23-year-old female with CML presented with progressively worsening ascites and pleural effusion despite first-line tyrosine kinase inhibitor treatment.Her blood work indicated leukocytosis with myelocyte bulge and 2%blasts.Analysis of the patient’s bone marrow confirmed the chronic phase of CML.Abdominal ultrasound revealed hepatosplenomegaly with ascites.The fluid investigation of both ascites and pleural effusion revealed a predominance of neutrophils with exudate.However,no acid-fast bacilli or growth was observed after culturing.Although hydroxyurea reduced cell counts,there was no observed effect on ascites or pleural effusion.Repeat investigation of the ascitic and pleural fluid revealed a polymorphous myeloid cell population consisting of myelocytes,metamyelocytes,band forms,neutrophils and a few myeloblasts.Extramedullary blast crisis was suspected,and mutation analysis was performed.We switched the patient to dasatinib.The patient’s symptoms were relieved,and ascites and pleural effusion diminished.CONCLUSION Serosal membrane involvement in CML is extremely rare.In this case,the patient responded well to dasatinib treatment.
文摘Objective To describe the impact of the global economic crisis on the nutritional status of children in China during and after the crisis.Methods Data from 1990 to 2010 were sourced from the National Food and Nutrition Surveillance System.Approximately 16 000 children under 5 years old were selected using a stratified random cluster method from 40 surveillance sites.Anthropometric and hemoglobin measurements for children under 5 were conducted.Nutritional status was determined according to WHO child growth standards.Results Prevalence of underweight and stunting in children under 5 had a downward trend.Underweight prevalence was close to normal (less than 5%),with prevalence of stunting 12.6% in 2009 and 12.1% in 2010 in rural areas.Prevalence of stunting in infants under 6 months and 6‐12 months old in poorer rural areas increased from 5.7%‐9.1% and 6.7%‐12.5%,respectively,in 2008‐2009.This trend also continued post‐crisis in 2010.Prevalence of stunting in children left behind by mothers was 20%‐30% higher than in children the same age in general and poorer rural areas.Prevalence of anemia in children did not change in rural areas,but prevalence of anemia in all age groups increased in poorer rural areas,especially in children under 24 months old.Level reached 30%‐40% in 2009,and fluctuated in 2010.Conclusion The nutritional status of children under 5 was comparatively stable during and after the global economic crisis,attributable to the Chinese government's policy response.The nutritional status in poorer rural areas fluctuated in response to the economic crisis and,thus,relevant action and intervention must be taken immediately to help the most vulnerable population in poorer rural areas.A proper national nutritional strategy for children under 2 years old,including nutrition supplementation for pregnant women and in‐home fortification for complementary feeding,should be initiated.
文摘In order to explore the changes and the roles of TXA2 and PGI2 during postoperative hypertensive crisis in patients with hypertensive intracerebral hemorrhage, 31 cases subject to craniotomy were divided into three groups: group A, 9 patients with postoperative hypertensive crisis; group B, 13 patients without postoperative hypertensive crisis; and group C, 9 patients without history of hypertension and hypertensive intracerebral hemorrhage. TXA2, TXB2, 6-keto-PGF1α and PGI2 were measured after operation in the three groups respectively. The postoperative blood pressure in group A, including SBP and DBP, was elevated more obviously than that in the other two groups. TXA2 and PGI2 in group A were significantly higher than those in other two groups (P〈0.01). Moreover, the ratio of TXB2 to 6-keto-PGF1α in group A was significantly higher than that in other two groups (P〈0.05). The increase of TXA2 and the relative inadequacy of prostacyclin, especially 6-keto-PGF1α, may play roles in the postoperative hypertensive crisis. And the increased value of TXB2 to 6-keto-PGF1α could provide the basis for diagnosis of postoperative hypertensive crisis.
基金Supported by Scientific Research Program on Agriculture,Forestry,Animal husbandry,Fishery in Jiangxi Province (Ny0935,Ny0936)
文摘In order to study the entrepreneurship situation of Jiangxi return migrant workers after the financial crisis,we have conducted a survey on 107 entrepreneurial return migrant workers in 6 counties of Jiangxi Province.The results show that the return of migrant workers is mainly attributed to personal factors,while social factors are also very important.The major difficulties facing return migrant workers are the funding difficulties,complicated formalities to start a business,difficulty in safeguarding their rights and interests,their own low quality and so on.The support needed by the return migrant workers from the government is manifested in five aspects,say,to improve the service and management for the entrepreneurship of migrant workers,to provide financing policy support,to increase the preferential fiscal and taxation policies,to enhance the entrepreneurship training and to provide preference for the return migrant workers to use land.