Impact of the economic crisis and drug shortage on Lebanese cancer patients’care

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.

Exploring the Contribution of Pharmacists in Addressing the Opioid Crisis through Naloxone Prescriptions and Pharmacist-Led Interventions

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.

An Appraisal of the Major National Dialogue as a Panacea to the Anglophone Crisis in Cameroon

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.

Modeling Study of the Evolution of the Climate Crisis over Time

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: CO2, 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 CO2, 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.

Research on the Status Quo of Psychological Crisis Among College Students in Ethnic Areas

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.

Feature Selection with Optimal Variational Auto Encoder for Financial Crisis Prediction

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.

The aggregate and sectoral time‑varying market efficiency during crisis periods in Turkey:a comparative analysis with COVID‑19 outbreak and the global financial crisis

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.

Exploring the Impact of Crisis and Trauma on the Mental Health and Psychological Well-Being of University Students in Northern Haiti

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.

Pulmonary Hypertension Crisis in Patient with Tetralogy of Fallot and Mixed Total Anomalous Pulmonary Vein Connection after the Primary Correction:A Rare Case Report

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.

Tuberculosis-induced aplastic crisis and atypical lymphocyte expansion in advanced myelodysplastic syndrome:A case report and review of literature

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.

The Acute Angle Closure Crisis in Senegalese Melanodermas: Epidemiological and Clinical Aspects of 24 Cases

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 0.34/10e. 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. .

The Taiwan Question China From the Perspective of International Crisis Management:History and Future

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.

Regional Tourism Resilience under Crisis Impacts:The Cases of Yangtze River Delta and Pearl River Delta

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.

Matching Consequences and Causes in Crisis Public Relations

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.

Unusual presentation of extramedullary blast crisis in chronic myeloid leukemia:A case report

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.

The Construction of Community Under the Subprime Crisis in Sunset Park

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.

Ecological problems and ecological restoration zoning of the Aral Sea

The Aral Sea was the fourth largest lake in the world but it has shrunk dramatically as a result of irrational human activities, triggering the "Aral Sea ecological crisis". The ecological problems of the Aral Sea have attracted widespread attention, and the alleviation of the Aral Sea ecological crisis has reached a consensus among the five Central Asian countries(Kazakhstan, Uzbekistan, Tajikistan, Kyrgyzstan, and Turkmenistan). In the past decades, many ecological management measures have been implemented for the ecological restoration of the Aral Sea. However, due to the lack of regional planning and zoning, the results are not ideal. In this study, we mapped the ecological zoning of the Aral Sea from the perspective of ecological restoration based on soil type, soil salinity, surface water, groundwater table, Normalized Difference Vegetation Index(NDVI), land cover, and aerosol optical depth(AOD) data. Soil salinization and salt dust are the most prominent ecological problems in the Aral Sea. We divided the Aral Sea into 7 first-level ecological restoration subregions(North Aral Sea catchment area in the downstream of the Syr Darya River(Subregion Ⅰ);artificial flood overflow area in the downstream of the Aral Sea(Subregion Ⅱ);physical/chemical remediation area of the salt dust source area in the eastern part of the South Aral Sea(Subregion Ⅲ);physical/chemical remediation area of severe salinization in the central part of the South Aral Sea(Subregion Ⅳ);existing water surface and potential restoration area of the South Aral Sea(Subregion Ⅴ);Aral Sea vegetation natural recovery area(Subregion Ⅵ);and vegetation planting area with slight salinization in the South Aral Sea(Subregion Ⅶ)) and 14 second-level ecological restoration subregions according to the ecological zoning principles. Implementable measures are proposed for each ecological restoration subregion. For Subregion Ⅰ and Subregion Ⅱ with lower elevations, artificial flooding should be carried out to restore the surface of the Aral Sea. Subregion Ⅲ and Subregion Ⅳ have severe salinization, making it difficult for vegetation to grow. In these subregions, it is recommended to cover and pave the areas with green biomatrix coverings and environmentally sustainable bonding materials. In Subregion Ⅴ located in the central and western parts of the South Aral Sea, surface water recharge should be increased to ensure that this subregion can maintain normal water levels. In Subregion Ⅵ and Subregion Ⅶ where natural conditions are suitable for vegetation growth, measures such as afforestation and buffer zones should be implemented to protect vegetation. This study could provide a reference basis for future comprehensive ecological management and restoration of the Aral Sea.

Unmasking Oppression:A Beauvoirian Analysis of Gender Dynamics in Bapsi Sidhwa’s Pakistani Bride

Delving into the intricacies of Pakistani society,this study offers a poignant exploration of the profound identity crises experienced by women,as depicted in Bapsi Sidhwa’s seminal work,Pakistani Bride(1990).Sidhwa’s narrative serves as a compelling lens through which to examine the multifaceted challenges faced by women within the patriarchal confines of Pakistani culture.Through the character of Zaitoon,Sidhwa adeptly navigates the intersections of tradition,patriarchy,and societal expectations,shedding light on the marginalized status of women in Pakistan.Employing qualitative research methods and drawing upon the theoretical framework of Simone de Beauvoir’s Second Sex(1949),this study delves into the nuanced complexities of female identity formation within a male-dominated society.Key themes such as identity subjugation,patriarchy,and the clash between social and traditional boundaries are meticulously analyzed.This research not only offers a critical examination of Sidhwa’s narrative techniques but also serves as a potent call to action,urging societal introspection and advocating for the empowerment of women in Pakistani society.

从CRISIS探究美国经济状况——基于语料库的CRISIS研究

本文以COHA、COCA两个美国语料库提供的大量客观、真实的数据为依据,探讨CRISIS在近200年的历时演变及其搭配词的特征,以期从话语研究中获取美国的经济状况信息。研究表明:(1)从20世纪30年代开始,CRISIS的使用频率突然飙升,而后一直都是美国大众关注的重点;(2)CRISIS的搭配词具有很强的商务性倾向,ECONOMIC CRISIS与FINANCIAL CRISIS共现频率最高;ECONOMIC CRISIS与ENERGY CRISIS分别对应20世纪30年代和70年代美国面临的最严重的两次危机,也成为了这两个时期美国经济的标志性事件;(3)在动词性搭配词方面,最常见的搭配词是FACING。统计对比后发现,应对危机的具有积极语义韵动词在语料库中共现的频率高于具有消极语义韵的动词,这表明美国社会在积极寻求解决危机的途径与方法。

Infinite Loop?What Is Behind the Ongoing Turmoil in the Banking Sector?

The war in Ukraine is unfortunately not over,to add insult to injury,Silicon Valley Bank collapses and Credit Suisse acquired by UBS under the Swiss emergency legislation.The merger of Credit Suisse with UBS,Switzerland’s biggest bank,has also raised concerns about the proliferation of more institutions deemed“too big to fail”.Through the study of four financial crises in the past 100 years,this paper believes that behind this potential financial crisis is still the real estate bubble,but the significant problems in the United States are the most worrying.Post-financial crisis recessions are costlier and last longer than normal recessions.When credit booms are superimposed with asset price bubbles,financial crises are highly likely and economic recovery will be slower.In this paper,relative data and regression model are used to analyze the causes of the crisis;further this paper discusses the reasons behind the financial crisis and related conjectures and gives relevant development speculations.