Практика формирования мультимодальных туристических кластеров за рубежом

To compare trends in the use of robot-assisted radical cystectomy (RARC) and changes over time in peri-operative outcomes in selected North American and European centres. We conducted a retrospective evaluation of 2401 patients treated with open radical cystectomy (ORC) or RARC for bladder cancer at 12 centres in North America and Europe between 2006 and 2018. We used the Kruskal-Wallis and chi-squared test to evaluate differences between continuous and categorical variables. Overall, 49.5% of patients underwent RARC and 51.5% ORC. RARC became the most commonly performed procedure in contemporary patients, with an increase from 29% in 2006-2008 to 54% in 2015-2018 (P < 0.001). In the North American centres the use of RARC was higher than that of ORC from 2006, and remained stable over time, whereas in the European centres its use increased exponentially from 2% to 50%. In both groups patients who underwent RARC had less advanced T stages (P < 0.001), lower American Society of Anesthesiologists scores (P < 0.05), lower blood loss (P = 0.001) and shorter length of hospital stay (P < 0.05). No differences were found in early complications. Early readmission and re-operation rates were worse for patients treated with RARC in the European centres; however, when contemporary patients only were considered, the statistical significance was lost. The present study shows that the use of RARC has constantly increased since its introduction, overtaking ORC in the most contemporary series. While RARC was more frequently performed than ORC since its introduction in the North American centres and its use remained substantially stable over time, its use increased exponentially in the European centres. The different trends in use of RARC/ORC and changes over time in peri-operative outcomes between the North American and European centres can be attributed to the earlier introduction and spread of RARC in the former compared with the latter.

To examine baseline characteristics of patients recruited into ADOPT, a multinational trial comparing three oral glucose-lowering monotherapies. Between April 2000 and June 2002, 4360 patients aged 30-75 years with Type 2 diabetes diagnosed for < 3 years and remaining on diet therapy alone with fasting plasma glucose levels (FPG) between 7.0 and 10.0 mmol/l were enrolled by 488 North American and European centres. Medical histories, anthropometric data and laboratory measurements were determined using common methodologies. The mean (SD) age of the patients was 57 (10) years, body mass index 32.2 (6.4) kg/m(2), HbA(1c) 7.4 (0.9)%; 58% were male, 88% Caucasian and 15% smoked. North American Caucasians (NAC) were younger, more obese, and more insulin resistant than European Caucasians (EUC), but had better pancreatic B-cell function. NAC had lower total, low-density lipoprotein- and high-density liporpotein-cholesterol concentrations with higher triglyceride concentrations and were more often on lipid-lowering treatment. They had lower blood pressure levels but were equally likely to be on antihypertensive treatment. Metabolic syndrome was more frequent and microalbuminuria less frequent in NAC. Within North America, NAC had lower HbA(1c) concentrations than Blacks, Hispanics and Asians despite similar or higher FPG and 30-min postchallenge glucose concentrations. Caucasian North American and European ADOPT patients differ with respect to adiposity, insulin resistance and metabolic syndrome prevalence. North American Blacks, Hispanics and Asians had lower HbA(1c) concentrations than NAC despite similar or higher glucose concentrations. These phenotypic differences may influence the progression of Type 2 diabetes and the response to initial oral glucose-lowering monotherapy.

Root reimplantation has been the favoured approach for patients with heritable aortic disorder requiring valve-sparring root replacement. In the past few years, root remodelling with annuloplasty has emerged as an alternative to root reimplantation in the general population. The aim of this study was to examine the late outcomes of patients with heritable aortic disorder undergoing valve-sparring root replacement and compare different techniques. Using the AVIATOR registry (Aortic Valve Insufficiency and ascending aorta Aneurysm InternATiOnal Registry), data were collected from 5 North American and European centres. Patients were divided into 4 groups according to the technique of valve-sparing used (root reimplantation, root remodelling with ring annuloplasty, root remodelling with suture annuloplasty and root remodelling alone). The primary endpoints were freedom from aortic regurgitation (AR) ≥2 and freedom from reintervention on the aortic valve. Secondary endpoints were survival and changes in annular dimensions over time. A total of 237 patients were included in the study (reimplantation = 100, remodelling + ring annuloplasty = 76, remodelling + suture annuloplasty = 34, remodelling alone = 27). The majority of patients had Marfan syndrome (83%). Preoperative AR ≥2 was present in 41% of the patients. Operative mortality was 0.4% (n = 1). No differences were found between techniques in terms of postoperative AR ≥2 (P = 0.58), reintervention (P = 0.52) and survival (P = 0.59). Changes in aortic annulus dimension were significantly different at 10 years (P < 0.05), a difference that started to emerge 4 years after surgery. Overall, valve-sparring root replacement is a safe and durable procedure in patients with heritable aortic disorder. Nevertheless, root remodelling alone is associated with late annular dilatation. The addition of an annuloplasty, however, results in similar freedom from AR, reintervention, survival and changes in annulus size compared to reimplantation.

To investigate whether or not the considerable regional differences in prescribing further modifications to initial empirical regimen were due to differences in the patient populations or were the result of other factors we re-analysed the data from a large multicentre study of monotherapy for the empirical treatment of febrile, neutropenic patients. We matched 151 episodes treated in 14 centres in Europe with the same number treated in 17 centres in North America for age > 46 years, gender, acute leukaemia, antibacterial prophylaxis, intravascular catheter use, receipt of ceftazidime or piperacillin plus tobramycin which were the regimens in the original study, the presence of bacteraemia at the onset of fever and the occurrence of a focus of infection within the first 3 days of empirical therapy. The initial regimen was in fact unchanged and successful after 72h for 74% of episodes treated in European centres and 45% of those treated in North American centres (p <.0001) and 38% and 21% of episodes respectively were managed successfully without any modification of therapy (p =.0044). Amphotericin and acyclovir were given in 35% and 11% of episodes treated in European centres compared with 53% and 25% of episodes treated in North American centres (p =.0053 and.0029). Moreover, empirical therapy was changed after a mean 4.8 days (95% Cl± 0.8) in North American centres but after 7.1 days (95%CI±1.0) in European centres (p =.0004) and there were 2.3±0.3 changes to therapy compared with 1.5±0.3 changes respectively (p =.0002). However there was no significant difference in survival (97% in and 96%), in the number of episodes complicated by a subsequent infection (10% and 11%), in the incidence of other adverse event (11% and 10%) nor in the proportion of episodes in which fever persisted longer than 5 days (53% and 48%) in North American centres and European centres respectively. The duration of fever (8.4±1.4 days and 7.1 ±1.2 days), antimicrobial therapy (19.8±1.9 days and 16.3±1.5 days) and neutropenia <0.5×109/L (19.9±2.9 days and 16.8±2.1 days) were also similar for North American centres and European centres respectively. These results suggest a genuine regional difference in medical practice does, in fact, exist.

Background: Sensitization to weed pollen allergens at the molecular level is not fully understood. We studied IgE reactivity to the major mugwort allergen Art v 1 in relation to allergens from other weed pollen and cross-reactive components in mugwort-sensitized subjects. Methods: Art v 1 and Amb a 1 were affinity purified and coupled to experimental ImmunoCAP® tests. Samples from North Europe (n = 50), South Europe (n = 19) and North America (n = 41) were analyzed for IgE against mugwort pollen, weed allergen components, pan-allergens and cross-reactive carbohydrate determinants (CCDs). Results: The prevalence of IgE reactivity (>0.35 kU_A/l) to Art v 1 was significantly higher in samples from North Europe than in those from North America. IgE to Amb a 1 was more common in North America than in North and South Europe, while IgE to Par j 2 was common in South Europe, less common in North America, and absent in North Europe. IgE to Art v 3 in mugwort-allergic patients was more common in North Europe than in South Europe and North America, while IgE to Sal k 1 was similar between the areas. Subjects with an Art v 1/mugwort-specific IgE ratio <0.5 had more often IgE to Amb a 1, profilin, polcalcin and CCDs than subjects with a ratio >0.5. Conclusions: Mugwort-sensitized subjects have different IgE reactivity profiles to weed allergens, reflecting their exposure to various pollens. Subjects with a low ratio between the IgE levels to Art v 1 and mugwort have a diverse IgE reactivity profile, indicating a role for cross-reactive allergens in their mugwort sensitization.

TPS256 Background: Single-agent PLD is an established therapy for platinum-refractory/resistant advanced ovarian cancer with response rates of approximately 20%. This ongoing study will assess antitumor activity and safety of PLD with or without IMC-3G3 in this population. IMC- 3G3 is an IgG1-type recombinant human monoclonal antibody which specifically targets PDGFRα with high affinity, blocks ligand-induced cell mitogenesis and receptor autophosphorylation, and inhibits phosphorylation of the downstream signaling molecules Akt and MAP kinase (Mol Cancer Ther 2005;4:369). PDGFRα is expressed in 52% of ovarian cancers, including in 89% with clear cell histology (Oncogene. 2002;21:6289). PDGF and PDGFRα are often co-expressed in ovarian cancers, suggesting an autocrine mechanism of tumor growth, and PDGFRα expression is associated with shorter survival in patients (Ca Res 1993; 53: 4550). Ovarian cancer-associated ascites fluid contains PDGF, and can stimulate ovarian cancer growth through PDGFRα signaling, highlighting a potential mechanism of intraperitoneal disease spread (Oncogene. 2006;25:2060). IMC-3G3 inhibits proliferation and growth of several human tumor cell lines in vitro and in vivo and enhances the antitumor effect of doxorubicin in xenograft models (ImClone Systems, data on file). Methods: One hundred ten patients with platinum- refractory/resistant ovarian cancer will be enrolled at 13-15 North American and European centers. Progression-free survival is the primary endpoint. Potential associations between clinical outcomes and tumor PDGFRα expression and serum vascular endothelial growth factor (VEGF)/PDGF levels, and the relationship between IMC-3G3 treatment and serum VEGF/PDGF levels will be assessed. Patients will be randomized to receive IMC-3G3 (20 mg/kg) every two weeks with PLD (40 mg/m2) every 4 weeks (Arm A), or doxorubicin alone (Arm B) until disease progression or other withdrawal criteria. Patients in Arm B may receive IMC-3G3 monotherapy upon disease progression. As of January 2010, 25 patients have been enrolled at 6 sites. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration ImClone Systems ImClone Systems ImClone Systems

The genusDrepanaphisdel Guercio currently includes 16 species, all of which are found in North America. Representatives of this genus are narrow oligophages associated mainly with plants of the genusAcer.Previous studies have focused only on the morphology of selected species, while not considering their geographical distribution. Among all species, the painted maple aphidDrepanaphis acerifoliaedeserves particular attention, because it represents the broadest range in North America and is the only species of this genus to be found outside of its natural range, i.e. in Europe. Thanks to suitable niche modelling based on a maximum entropy model, we were able to present maps with the potential distribution ofD.acerifoliaein its natural range. In North America, its distribution coincides with the natural range of the host plants (native to the eastern part), as well as the areas where they are planted (the western part). An extrapolation of these results to the area of Europe allowed for the designation of places where the aphids can find suitable climatic conditions for developing and expanding their spatial distribution. The model indicated the Mediterranean basin, almost all of Italy, excluding mountainous areas, Spain, Portugal, France, Belgium, the Netherlands, the western part of Germany, the southeast and central part of Great Britain, Hungary and the Balkan Peninsula. In a more continental view, the model pointed to areas stretching from the middle of eastern Ukraine, including Crimea, through Russia, to northern parts of Kazakhstan along the border with Russia. Additionally, the impact of climate change on the spread of the species within the next 80 years was analysed, both in North America and Europe. Models considering the potential future climate changes indicate thatD.acerifoliaemay find suitable niches further north of its current ranges. In North America, this is mostly areas of eastern Canada, while in Europe it includes the central and eastern part and the Asian part of Russia.

To study a comparison of problems arising in pulmonary rehabilitation programs in North America, Europe, and Tokyo. The survey instrument was a 13-item questionnaire sent in December 1994 to institutions in North America (n = 178), Europe (n = 179), and Tokyo (n = 399). Response rates were 51%, 40%, and 51% for North America, Europe, and Tokyo, respectively. Pulmonary rehabilitation programs were available at 56% of hospitals in North America and 74% in Europe, but at only 20% of hospitals in Tokyo. Most PRPs were conducted in an outpatient setting in North American (98%), whereas both outpatient (55%) and inpatient programs (65%) were adopted in Europe. Although the type of lung disease for which patients in both North America and Europe were referred to PRPs was mainly chronic obstructive pulmonary disease, this accounted for only 34% of referrals in Tokyo. However, referrals for primary tuberculosis sequelae (P = 0.028) and bronchiectasis (P = 0.021) were more common in Europe, similar to the situation in Tokyo. The following PRP items were available at significantly higher rates in North America than in Europe, and most were unavailable in Tokyo: family education, psychological support, nutritional instruction, treadmill, bicycle ergometer, walking training, and increasing the activity of daily living. Pulmonary rehabilitation programs in North America are more multidimensional. However, target diseases differ among North America, Europe, and Tokyo. Pulmonary rehabilitation programs in Tokyo differed from those in North America and Europe and were poorly programmed. Problems arising in PRPs in the three regions include lack of staff and insufficient reimbursement.

BackgroundThe prevalence of congenital heart defects (CHD) in Down syndrome (DS) varies considerably across studies (from 16% to 84%). This study aimed to estimate the prevalence of CHD in people...

The number of South Asians (people originating from India, Pakistan, Sri Lanka, Bangladesh, and Nepal) in North American and European workplaces has been increasing steadily (Budiman & Ruiz, 2021; Berentsen & East, 2024). However, despite the increasing number, South Asians remain underrepresented in organizational scholarship (Lee & Ramakrishnan, 2020). This exclusion is partly due to the model minority myth that portrays all Asians, including South Asians, as successful, hardworking, and intelligent (Lai & Babcock, 2013). As a result, Asians are perceived as uniformly doing well, overshadowing their struggles as not significant. Further, looking at the experiences of the consolidated “Asian” category represents significant challenges in both research and practice as it masks the socioeconomic inequality and key socio-psychological differences among the Asian subgroups (Lu, 2024). Distinguishing the experiences of various Asian subgroups is essential, as South Asians have distinct cultural patterns and are perceived differently from East and Southeast Asians (Tewari, Inman, & Sandhu, 2003). The exclusion of South Asians from discrimination research, coupled with limited understanding of their lived experiences, underscores the need for deeper inquiry into their unique cultural dynamics, workplace experiences, and the specific opportunities and challenges they encounter. Research has indicated that Asian American women face the effects of both racism and sexism creating heightened invisibility and discrimination (Mukkamala & Suyemoto, 2018). There have been calls to better understand the experiences and gendered stereotypes of South Asian women (Eagly, 2020). Beyond the intersectionality of race and gender, other dimensions such as religion, social class, caste, birthplace, immigrant generation, and geographic region critically shape the lived experiences of South Asian women. These intersecting identities influence their intrapersonal identity network, affecting how they negotiate and manage their identities within various social and professional contexts (Ramarajan, 2014; Bataille & Vough, 2022). This also has an impact on the stereotype implications for these South Asian women given the MOSAIC (model of stereotyping through associated and intersectional categories) of the intersectional and foundational stereotypes that come into play (Hall et al., 2019). Building on the AOM 2024 session, Understanding South Asian Women’s Experiences and Challenges in North America: Future Directions for Scholarship, this symposium extends the understanding of the lived experiences of South Asian women by broadening the context to Europe, bringing in further intricacies within the South Asian diaspora such as religion, immigration status, and class, and their associated implications and challenges, and navigation strategies. Panelists will discuss a range of topics on their lived experiences and research related to the race- gender-ethnicity intersection for South Asian women and the strategies employed in academia and other workplaces, such as: 1) Do cultural identities create differential experiences for South Asian women, as compared to other women of color, or more broadly, other women in North America and Europe?; 2) How does immigration status impact this experience?; 3) Do first- and second- generation South Asian women have differential experiences in North America and Europe?; 4) What are some of the other key intersectional identities that impact South Asian women’s experiences such as religion, class, caste, gender etc.? How?; 5) Evolution of South Asian identity, and especially the South Asian woman's identity in North America and Europe and across career stages; 6) Advantages and disadvantages of being a South Asian woman in academia / other workplaces in North America and Europe; 7) Techniques used to manage disadvantages / barriers in academia / other workplaces in North America and Europe; 8) State of research on South Asians in North American and European workplaces; 9) How can we broaden DEI research to include under-studied populations in North America and Europe, such as South Asian women, while ensuring applicability in top-tier journals?

Purpose The purpose of the chapter is to compare social and economic effects that accompany crises of economic systems. Methodology According to the adopted classification of causes of conflicts of socio-economic systems, the indicators that reflect potential social and economic causes of crisis are determined. Regression analysis is performed, and multiple regression dependence of economic growth of Russia’s economic system (values of growth of GDP in constant prices) on the indicators that characterize social and economic causes of crisis is determined; correlation analysis is performed and correlation of each indicator of causes and the indicator of economic growth is determined. Conclusions It is shown by the example of modern Russia that subjective (social factors) have the key role in determining cyclic fluctuations of economic system – together with objective (economic effects). Social causes of crisis are almost as important as economic causes. In view of generally acknowledged social consequences of crises (growth of inflation and unemployment level), it is possible to state a relatively equal role of economic and social effects that accompany crises of economic systems. The information and empirical basis of the chapter consists of the statistical materials of the International Monetary Fund, the World Bank, and the OECD. The research is performed by the example of modern Russia’s economic system; its timeframe covers 1999–2018 (recent 20 years). Originality/value The obtained conclusions show the necessity and open perspectives for specifying the existing theory of cycles in the aspect of inclusion of social effects into the model of cyclic (wave) fluctuations of economic systems.

110. Feasibility of achieving planned surgical margins in primary spine tumor: a PTRON study

Dual mycorrhizal symbiosis, i.e., the association with both arbuscular and ectomycorrhizal fungal symbionts, is an ambiguous phenomenon concurrently considered as common among various genetic lineages of trees and a result of bias in data analyses. Recent studies have shown that the ability to form dual mycorrhizal associations is a distinguishing factor for the continental-scale invasion of alien tree species. However, the phylogenetic mechanisms that drive it remain unclear. In this study, all the evidence on root-associated symbionts of Juglandaceae from South and North America, Asia, and Europe was combined and re-analysed following current knowledge and modern molecular-based identification methods. The Juglandaceae family was revealed to represent a specific pattern of symbiotic interactions that are rare among deciduous trees and absent among conifers. Closely related phylogenetic lineages of trees usually share the same type of symbiosis, but Juglandaceae contains several possible ones concurrently. The hyperdiversity of root symbionts of Juglandaceae, unlike other tree families, was concurrently found in Central and North America, Asia, and Europe, indicating its phylogenetic determinants, which endured geographical isolation. However, for many Juglandaceae, including the invasive Juglans and Pterocarya species, this was never studied or was studied only with outdated methods. Further molecular research on root symbionts of Juglandaceae, providing long sequences and high taxonomic resolutions, is required to explain their ecological roles.

The winners and losers of El Niño

Most HIV-1 subtype B infections in North America and Europe seem to have resulted from the expansion of a single pandemic lineage (BPANDEMIC) disseminated from the United States (US). Some non-pandemic subtype B strains of Caribbean origin (BCAR) may have also reached North America and Europe, but their epidemiological relevance in those regions remains largely unknown. Here we analyze a total of 20,045 HIV-1 subtype B pol sequences from the US, Canada, and Europe, to estimate the prevalence and to reconstruct the spatiotemporal dynamics of dissemination of HIV-1 BCAR strains in those regions. We find that BCAR strains were probably disseminated from the Caribbean into North America and Europe at multiple times since the early 1970s onwards. The BCAR strains reached the US, Canada and at least 16 different European countries, where they account for a very low fraction (<5%) of subtype B infections, with exception of the Czech Republic (7.7%). We also find evidence of the onward transmission of BCAR clades in the US, Canada, the Czech Republic, Germany, Italy, Spain and the UK, as well as short-distance spreading of BCAR lineages between neighboring European countries from Central and Western Europe, and long-distance dissemination between the US and Europe.