In this paper, we first study the existence of ground state solutions for the following Schrödinger systems { − ∆ u + V ∞ u = G u ( u , v ) , x ∈ R N , − ∆ v + V ∞ v = G v ( u , v ) , x ∈ R N , u , v > 0 , u , v ∈ H 1 ( R N ) , where N≥3 and G ∈ C 2 ( ( R + ) 2 , R ) . And then, by using variational method and projections on Nehari-Poho z ̆ aev type manifold, we will prove the nonexistence of ground state solutions for the coupled Schrödinger systems { − ∆ u + V ( x ) u = G u ( u , v ) , x ∈ R N , − ∆ v + V ( x ) v = G v ( u , v ) , x ∈ R N , u , v > 0 , u , v ∈ H 1 ( R N ) .

：Crack Tip Opening Angle (CTOA) is considered and has been attempted to be used as a fracture parameter to describe the crack arrest toughness of ductile steel gas pipelines. However, its evolution and influencing factors during pipeline dynamic crack propagation are still unclear, and its use as a crack arrest toughness parameter similar to the Charpy impact toughness also lacks theoretical support. In view of the above problems, this paper reproduces the full-scale test with the help of the numerical simulation method for pipeline dynamic crack propagation. Comparing the numerical simulation results with the experimental ones, it is proved that the numerical model is reliable in studying the pipeline CTOA evolutions. On this basis, this paper systematically studies the evolution laws of CTOA in the process of dynamic crack propagation and arrest for natural gas pipelines, and clarifies the effects of the following factors on CTOA values, including the design factor, geometric dimensions, inertia backfill effect and material property of pipeline steel, et al. The results show that the critical CTOA (CTOA C) of a pipeline is independent of the design factor, the pressure decompression, and the large change in the crack velocity, and is also not sensitive to the pipe strength, pipe wall thickness, and the inertial effect of soil, but only related to the pipe diameter and pipe toughness. The above conclusions show that it is reasonable to use CTOA as the crack arrest toughness parameter and has laid a foundation for the subsequent establishment of the crack arrest control method for natural pipelines based on CTOA C.

Oculocerebral syndrome (OCRL),or Lowe’s syndrome (LS), is an X-linked recessive disorder that primarily affects males and is characterised by growth retardation, mental retardation, congenital cataract,and Fanconi syndrome. We report the first case in our country of a young adult male with LS diagnosed at the stage of end-stage renal disease

The case is a 67-year-old female with autosomal dominant polycystic kidney disease who was followed up regularly. CT scan showed a mural nodule growing over the past 4 years inside the hypodense region surrounded by hepatic cysts. Surgery was performed and the pathological diagnosis was StageⅠ gallbladder cancer.

Background: Psychological distress is associated with worsening symptoms during the active treatment period and lower quality of life in women with early-stage breast cancer. Many studies have indicated risk for heightened psychological distress across the breast cancer trajectory. Aim: The purpose of this review is to examine the literature for instruments used to measure psychological distress among women with breast cancer during chemotherapy. Methods: This study used the Arksey and O’Malley framework of scoping reviews. Two databases, PubMed & CINAHL, were searched for peer-reviewed original articles that were published within the last ten years, included participants with a diagnosis of breast cancer stages I to III, and receiving chemotherapy, English text articles, and studies that report psychological distress measures.  Results: The initial screening yielded 529 relevant studies. After applying the exclusion criteria, a total of 17 studies concerning the assessment of psychological distress during chemotherapy were retained for the analysis of variables and measures of psychological distress. The instruments used to measure for psychological distress varied with a total of 22 measures. The most frequently utilized measure was the Hospital Anxiety and Depression Scale ( n=5), followed by the Impact of Event Scale ( n=2), the Distress Thermometer ( n=2), and the Perceived Stress Scale ( n=2).  Conclusion: This review identified the gaps related to inconsistencies in the operationalization and instruments used to measure psychological distress among breast cancer survivors during chemotherapy. Standardization of measures assessing psychological distress, along with conceptual clarity, is essential for measuring distress in research and clinical practice.

Background: The role and mechanism of centromeric protein N (CENPN), which has been associated with the development of various cancer types, are yet unclear in Gastric adenocarcinoma (STAD). Methods: Data from The Cancer Genome Atlas and Genotype Tissue Expression were used to examine the expression of CENPN in STAD and neighboring tissues. Xiantao Academic was used to perform Gene Ontology(GO) and Kyoto Encyclopedia of Genes and Genomes(KEGG) enrichment analysis on CENPN. By reviewing TCGA database, the relationship between CENPN expression and immune cell infiltration was assessed. The expression of CENPN in STAD and surrounding tissues was confirmed by immunohistochemical staining, and the correlation between CENPN expression and clinicopathological characteristics was examined. CENPN was depleted in AGS cells with siRNAs, and its impact on proliferation was measured by CCK-8 and EdU assays. Following siRNA transfection, flow cytometry was performed to identify cell cycle and apoptotic alterations in AGS cells. Results: CENPN was highly expressed in STAD tissues. The degree of invasion, TNM stage, and lymph node metastases were all substantially linked with CENPN expression. GO|KEGG Enrichment analysis revealed that CENPN was essential for the cell cycle, DNA replication, chromosomal segregation, and nuclear division, among other important signaling pathways. Further investigation revealed a positive correlation between CENPN expression and Th2 cells and NK CD56dim cells and a negative correlation between CENPN expression and mast cells , pDC cells,NK cells and B cells. When CENPN expression in AGS cells was knocked down, cell proliferation dramatically reduced, and the percentage of cells in the S and G2-M phases decreased significantly. In addition, compared to the control group, the proportion of apoptotic AGS cells significantly increased after downregulating the expression level of CENPN. Conclusion: According to our data, CENPN acts as an oncogene in STAD and may be a viable therapeutic target.

Moebius Syndrome is a rare multifactorial condition defined by congenital complete or partial VII and VIth cranial nerves palsy and other physical abnormalities. We present the case of a 3 months old infant with Moebius sequence and breathing and eating difficulties, managed by tracheostomy and laryngoplasty.

Experimental and theoretical studies show that two-dimensional (2D) materials have great potential applications in the fields of optoelectronics, semiconductors and spintronic devices. Based on the First Principles, the stability, band structure, electronic properties and optical properties of hydrogenated C3B, a new graphene like two-dimensional (2D) material, are studied in this paper. The results show that: firstly, with the increase of hydrogenation degree, the sp2 orbital hybridization in C3B structure gradually transits to a more stable sp3 mode, and the valence band energy near the Fermi level decreases; Secondly, adsorbed H atoms can regulate the bandgap of C3B. When the number of adsorbed H is even, C3B structure behaves as a semiconductor, and meanwhile the bandgap increases. When H atoms is odd, C3B is easy to show metallicity; Finally, the main absorption peak of the optical absorption spectrum decreases first and then increases with the increase of H concentration. The law of the secondary absorption peak is opposite to the main peak. When the ratio of hydrogenation is 50%, an obvious secondary absorption peak appears. This study confirms that hydrogenation is an effective way to regulate the electronic properties of materials, which can expand the application of 2D material C3B in optoelectronic devices.

We describe the ocular manifestations of Recessive Dystrophic Epidermolysis Bullosa ( RDEB) in a 7-year-old boy presented with localized corneal oedema and eyelid blisters without involving the epithelium and conjunctiva. We treated the lesion with topical loteprednol eye drops, and the outcome was excellent.

Purpose: To explore the screening value of the adenoidectomy / nasopharyngeal (A/N) ratio from nasopharyngeal lateral radiography in children with obstructive sleep apnoea hypopnea syndrome (OSAHS). Methods: Children who had visited the respiratory department due to snoring and/or mouth breathing’ were enrolled. Nasopharyngeal lateral radiography and polysomnography (PSG) were performed. PSG monitoring is the gold standard for OSAHS. The differences in PSG monitoring results among different A/N groups were compared, and the correlation between the A/N ratio and PSG monitoring results was analysed. The receiver operating characteristic curve (ROC) was plotted to evaluate the screening value of OSAHS in children with the A/N ratio from nasopharyngeal lateral radiography to determine the diagnostic critical point. Results: A total of 425 children were enrolled. A total of 183 patients (43.1%) were diagnosed with OSAHS, including 113 cases (26.6%) of mild OSAHS and 70 cases (16.5%) of moderate to severe OSAHS. A total of 52 patients (12.2%) had an A/N ratio ≤ 0.60, 77 patients (18.1%) had an A/N ratio from 0.61~0.70, 142 patients (33.4%) had an A/N ratio from 0.71~0.80, and 154 patients (36.2%) had an A/N ratio ≥0.80 The patients with moderate-severe OSAHS had a higher A/N ratio than those with mild OSAHS and non-OSAHS. The OAHI, ODI, and the diagnostic rate of OSAHS were higher and the LSaO 2 was lower in the A/N≥0.80 group than in the other three groups. Spearman’s rank correlation showed that the A/N ratio was correlated with OAHI, ODI, and LSaO 2 (r=0.275, 0.227, -0.225, respectively). The area under the ROC curve for the diagnosis of OSAHS by the A/N ratio was 0.659, the critical value was 0.825, and the sensitivity and specificity were 45.1% and 80.9%, respectively. An A/N ratio ≥0.825 was identified as the main influencing factor of OSAHS by logistic multivariable regression analysis. Conclusion: There is a correlation between the degree of adenoid hypertrophy and OSAHS, and an A/N ratio ≥0.825 has good suggestive value for the diagnosis of OSAHS but is not a substitute for PSG.

Objective: The causative virus of COVID-19 is SARS-CoV-2. The aim of the present study was to invastigate the in vivo virucidal activity of nasal irrigation with saline, nasal irrigation with Povidone-iodine (PVP-I) 1%, nasal irrigation with hypertonic alkaline and nasal irrigation with PVP-I 1% against SARS CoV- 2. Design: The present study was a prospective randomized clinical trial. Setting: A multicenter study involving tertiary care centers. Participants: The study included adult outpatients whose qualitative SARS-CoV-2 RT-PCR tests in nasopharyngeal swabs were positive. One hundred twenty patients divided into four equal groups. Standard COVID-19 treatment was given to group 1 (n=30), nasal irrigation containing isotonic solution was added to patients’ treatment in group 2 (n=30), nasal irrigation containing 1% PVP solution was added to patients’ treatment in group 3(n=30), and nasal irrigation containing 1% PVP solution and nasal irrigation containing hypertonic alkaline solution was added to patients’ treatment in group 4 (n=30). Main outcome measures: On the first day of diagnosis (day 0), nasopharyngeal swab samples were taken, on the 3rd and 5th days the nasopharyngeal viral load reduction in quantitative RT-PCR tests were calculated. Results: Between the 0-3rd Day and 0-5th days, the nasopharyngeal viral load reduction was significant in all groups (p< .05). In paired comparisons of groups, the nasopharyngeal viral load decrease in group 4 in first 3 days was significantly lower than all groups (p < .05). The nasopharyngeal viral load degrease in groups 3 and 4 in the first 5 days were significantly lower than group 1 (p < .05). Conclussion: This study was reveal that the use of hypertonic alkaline nasal irrigation together with 1% povidone-iodine was more effective in reducing viral load in the early period. The decreased nasopharyngeal viral load may reduce the carriage of infectious SARS-CoV-2 in patients. Our results suggest that 1% povidone-iodine and hypertonic alkaline nasal irrigation may be promising modality to prevent the COVID-19 epidemic.

Objective: to analyze and compare the available data on the outcomes of endoscopic and microscopic type I tympanoplasty. Data Sources: PubMed, Cochrane library Ovid, Scopus, Google scholar, and ClinicalTrials. Review Methods: We conducted a meta-analysis in accordance to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. We included comparative studies describing type I tympanoplasty, and comparing surgical outcomes of the endoscope with the microscope in terms of efficacy and safety. Results: Our systematic search yielded 22 studies meeting the inclusion criteria and eligible for analysis. The pooled graft uptake rates and audiological results of endoscopic and microscopic tympanoplasty demonstrated non-significant differences. In contrast, the endoscopic type I tympanoplasty outperforms the microscopic tympanoplasty regarding a highly significant decrease not only in pooled mean operative time, but also in the pooled rates of the additional maneuvers, postoperative pain and complications. Conclusions: Based on our meta-analysis, the surgical outcomes of endoscope-assisted and microscope-assisted type I tympanoplasty in terms of postoperative hearing outcomes and the graft uptake rate were comparable. On the contrary, operative time, additional maneuvers rate, postoperative pain rate and complications rate proved to be significantly reduced with endoscopy compared to microscopy. Hence, the endoscope is as efficient as the microscope in type I tympanoplasty but less invasive, fewer in complications and shorter in operative time.

Learning the complex skill of bronchoscopy involves the integration of cognitive domains and motor skills. The development of simulators has opened up new possibilities in bronchoscopy training. This study aimed at evaluating how effective the modelling example methodology is in training this skill and assessed its effect on cognitive load in learning. Methods: Forty-seven medical students participating in a simulator-based bronchoscopy training program were randomly allocated to a control group, receiving a video lesson, and the modelling example group. They were evaluated by the simulator’s metrics at different time points: pre-test, post-test and 15 days and 12 months after training. Cognitive load was assessed with the modified Paas scale. Results: Simulation-based training was effective for both groups, based on simulator metrics (p<0.05). The modelling example group outperformed the control group in all measures at post-test and after 15 days (p<0.001). After 12 months, there was a decline in skill in both groups, but the modelling example group performed better (p<0.001). Simulation-based training reduced cognitive load, more strongly so in the modelling example group (p<0.001). Conclusion: The modelling example group showed substantial benefits over the control group, both in reducing the cognitive load in learning and in retaining knowledge and skill after 15 days and 12 months.

Oil-immersed transformers will inevitably have various latent faults during the ageing process, therefore, it is very important to correctly diagnose the status of the transformer in a timely manner. The traditional three-ratio method based on dissolved gas analysis (DGA) data has an insufficient coding problem, limiting the effect of fault diagnosis. To solve this problem, an improved manta ray foraging optimization (MRFO) algorithm is proposed to optimize the fault diagnosis model of the Back-Propagation (BP) Network in this paper. This improved algorithm primarily uses a multi-stage algorithm that combines logical mapping and opposition based learning (OBL) to provide the initial position for the MRFO to strengthen the global optimization ability of the algorithm. Meanwhile, three foraging strategies of modified MRFO algorithm by using the orthogonal experiment method are proposed, to adjust the exploration and development of the manta ray individual, so as to strengthen the optimization ability of the algorithm on specific problems. As the result, the optimal solution obtained by the improved MRFO algorithm is given to the weights and biases of the BP network, and a transformer fault diagnosis system is established. In addition, experiments are carried out using IEC TC 10 fault data, and the experimental results are compared with algorithms. Comparative analysis and experimental results show that the accuracy of this improved algorithm is 16%, 8%, and 24% higher than the results of Back Propagation Neural Network(BP), unimproved Manta ray foraging optimization combined with Back Propagation Neural Network(MRFO -BP), and the three-ratio method, respectively

The voltage quality of the distribution network may be seriously impacted by distributed generations (DGs) and load in microgrid. How to accurately analyze the impact of power flow from microgrid integrated into the distribution network, to improve the voltage quality of the distribution network, are needed to be further studied. A novel microgrid power flow calculation and optimal control method based on multivariate stochastic factors fusion-sensitivity (MSFF-sensitivity) is proposed in this paper. The multivariate stochastic factors fusion (MSFF) function is firstly developed to extract the stochasticity and correlation of power flow among different stochastic factors in the microgrid; Further, the fusion-sensitivity (F-sensitivity) for the stochastic power flow of the microgrid integrated into the distribution network is created to precisely characterize the influence of various stochastic factors in the microgrid on the power flow of the distribution network. Based on this, the power flow of the distribution network is optimally controlled. Finally, the algorithm verification shows that, compared with the traditional microgrid power flow analysis and calculation method, the method proposed in this paper is more applicable to microgrid. By optimally controlling the power flow of the microgrid， the voltage quality of the distribution network can be improved.

With the development of smart distribution network and the proposal of dual carbon target, the importance of demand side management in improving the flexible operation of power system is becoming more and more prominent. In order to solve the problems of excessive load peak valley difference, insufficient utilization of demand side resources, and unreasonable pricing of aggregators, this paper propose an economic optimization scheme for aggregators based on electric vehicle three-stage dispatching. First, the loss aversion analysis is conducted on the willingness of electric vehicle users to participate in dispatching. The contract signing methods between aggregators and electric vehicles are divided into three categories: complete dispatching, rolling reward and punishment mechanism dispatching, and free dispatching. Next, the response model of electric vehicle users based on the improved cloud model is obtained. Then, the aggregators conduct three-phase optimal dispatching for electric vehicles according to the bid winning peak shaving capacity. Phase 1 according to the time of regional differences, the dispatching of reward power set rewards and punishment mechanism, phase 2 to determine the full freedom dispatching of electric vehicles, three kinds of dispatching and dynamic load capacity of electricity, phase 3 according to the phase 1 and 2, the amount of information and user loss aversion, the user response model of final rolling rewards and punishment mechanism, get the aggregators final pricing schemes, Finally, a numerical example is given to verify the feasibility of the proposed method.

In this paper, the impact of residential photovoltaic (PV) battery systems in a real test system with the goal of system peak load shaving is investigated. In order to encourage residential investors, a Levelized feed-in tariff (LFiT) scheme is introduced. Accordingly, two proposed cases and relevant suggestions are presented to reach a better performance. The profitability of the project is apprised via several economic criteria such as net present value (NPV), payback period years (PBY), internal rate of return (IRR), benefit to cost ratio (BCR), net cash flow (NCF), and Levelized cost of energy (LCOE). Moreover, different levels of peak shaving subject to customers’ participation and the size of the PV-battery system are also obtained. An actual test system regarding one-year recorded data is employed to elevate the precise of results. Furthermore, results are economically compared with the current situation in the test system to assess the effectiveness of the suggested system. Obtained results determine the best size of PV and battery to attain the preferable profitability. Meanwhile, the LFiT with respect to the economic criteria is specified as well. Finally, a sensitivity analysis on systems’ parameters is performed to identify the impact of these parameters on economic indices.

This research uses the Community Readiness Model (Oetting et al., 2014) developed by the Tri-Ethic Center at Colorado State University, and tested for validity, to gauge a mid-size university in the southern U.S. readiness to end sexual violence and propose practical action plans to effectively address the problem. Using interviews from 10 stakeholders that represent law enforcement, student government, leaders of student organizations, mental health, prevention, and administration we explored the following dimensions of readiness for change: community knowledge of the issue, knowledge of efforts to address the issue, leadership, resources, and community climate. Our findings indicate that on a scale 1-9, the university is at a 4-5 with a mode of 4, which is categorized as the pre-planning stage. Results indicate a lack of communication around ongoing programming and research efforts associated with sexual violence on campus as well as a lack of knowledge of what constitutes sexual violence and a reluctance to report. Prevention on this campus would need to start with streamlining communications about departmental programming efforts and increasing knowledge, dispelling myths, reducing stigma, and increasing the skills necessary to recognize and thus intervene in sexual violence.

Advantages of combined distal-first and visceral branch-first technique: A universal fit for extensive thoracoabdominal aortic aneurysm?Kenji Okada, MD, PhD, Taishi Inoue, MDDivision of Cardiovascular Surgery, Department of Surgery,Kobe University Graduate School of Medicine, Kobe, Japan.Corresponding author: Kenji OkadaDepartment of Cardiovascular Surgery, Kobe University Graduate School of Medicine7-5-2 Kusunoki-cho, Chuo-ku, Kobe , Hyogo 630-0005, JapanTel: +81-78-382-5942;Fax: +81-78-382-5959;E-mail: kokada@ med.kobe-u.ac.jpWord counts; 743 wordsMinimization of end organ ischemia is a key tenet in successful thoracoabdominal aortic aneurysm (TAAA) surgery. In recent years various techniques have been inspired and refined to reduce the duration and risk of visceral ischemia such as mild, moderate, or deep hypothermic repair with left heart bypass, or complete or partial cardiopulmonary bypass combined with selective perfusions to vital viscera, the lower extremities and the spinal cord. (1) (2) (3) Despite advances in surgical technique and organ protection strategies, open surgical repair for TAAA remains associated with considerable levels of morbidity and mortality. Moulakakis and colleagues conducted a meta-analysis which summarized the surgical outcomes of 9963 patients in experienced surgical centers and found that the mortality after repair of extent I-IV TAAA was 11.3%. (4) These results can be attributed to the nature of open surgical repair of TAAA, which represents the pinnacle of invasive cardiovascular surgery and comes with the burden of a relatively high association of comorbidities.Estrera and colleagues reported the “distal first approach” assumes the advantage of providing a distal fenestration and ensuring adequate antegrade blood flow at an early stage for patients with chronic aortic dissection. (5) Previous reports have described the utility of “visceral branch-first techniques” in reducing visceral ischemic time with minimal reperfusion injury. (6) (7) Marchenko and colleagues also successfully devised a novel “iliac branch first” strategy combined with the distal-first approach for Crawford extent II TAAA using a “neo-graft.” (8) A bifurcated graft of the neo-graft was anastomosed to the common iliac arteries first, followed by reattachments of the left renal artery, superior mesenteric artery and celiac axis without aortic cross-clamp. Ischemic time was no longer than 7 minutes for each anastomosis and extremely short compared to previous reports from experienced centers. This may minimize the risk or degree of ischemia-reperfusion injury even if no selective organ perfusion was applied. Since the right renal artery is located on the bottom of the aneurysm, the reconstruction was performed after initiating a left heart bypass (LHB). During these reattachments, antegrade pulsatile blood flow to the spinal cord was guaranteed not only via the Adamkiewicz artery but also the collateral network, which ultimately minimizes spinal cord ischemia. Next, the thoracic intercostal arteries were reimplanted using the island technique followed by proximal anastomosis of the main graft at the aortic isthmus. Overall LHB time was merely 32 minutes. The “iliac branch first” strategy eliminated the need for femoral artery exposure, which is particularly beneficial in obese patients.At a glance, these procedures appear to be a highly promising addition to the existing armamentarium of TAAA surgical techniques; however, the question remains whether they are applicable to all types of aortic pathologies? Starting with the simplest answers, the branch reconstructions prior to aortic decompression made it difficult to adjust the length of the branches, particularly in huge aneurysms. Longer branch grafts—in particular those to the left renal artery—the may cause kinking. Secondly, some iliac arteries are not always healthy and there unsuitable for end-to-side anastomosis, which may obstruct the establishment of the primary inflow source. Third, the current procedure is indeed suitable for chronic dissecting aortic aneurysms. By ligating the visceral branches prior to the aortic procedure, this technique not only reduced visceral ischemic time but also avoided the embolization of debris or thrombi. Therefore the “branch-first” technique appears to be a desirable option in terms of preventing embolic complications in the visceral organs. But let’s suppose that the aortic pathology is an atherothrombotic one (e.g. shaggy aorta). Yokawa and colleagues reported on thoracoabdominal repair in patients with shaggy aorta (atherothrombotic aorta)—a significant risk factor for organ infarction—and showed the relationship with spinal cord injury (SCI), acute kidney injury and perioperative mortality. (9) A shaggy aorta does not always allow segmental aortic cross-clamping such as at the levels of the diaphragm and the middle third of the descending aorta for reimplantation of the intercostal arteries. Furthermore, it may be difficult to reattach the major targeted intercostal arteries if the Adamkiewicz artery exists at lower levels such as Th12 or L1. Marchenko and colleagues used the current approach in 29 patients, but the aortic pathology of the patients is unknown. Therefore, the question remains whether the incidence of spinal cord ischemia in patients with atherothrombotic aorta could be reduced by the current technique.The approach comes with inherent advantages and we eagerly await the next series of evolution along with a report on the long-term results.

ARTIFICIAL CHORDAE FOR ANTERIOR LEAFLET PROLAPSE: ARE ALL THE ROADS LEADING TO ROME?Antonio Maria Calafiore (a), MD, Antonio Totaro (a), MD, Sotirios Prapas (b), MD, Diego Magnano, MD (a), Stefano Guarracini (c), PhD, Massimo Di Marco (d), MD, Michele Di Mauro (c,e), PhDDepartment of Cardiovascular Diseases, Gemelli Molise, Campobasso, ItalyDivision of Cardiac Surgery A, Henry Dunant Hospital, Athens, GreeceDepartment of Cardiology, “Pierangeli” Hospital, Pescara, ItalyDepartment of Cardiology, “S Spirito” Hospital, Pescara, ItalyCardio‐Thoracic Surgery Department, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands

In the recent past, due to the pandemic and humanitarian crisis, the healthcare system has dived into turmoil, especially regarding core facilities for women and maternal health. Afghanistan has the highest maternal mortality rate globally according to the WHO, with a startling 638 deaths per 100,000 live births. In such a decrepit system, regime changes resulted in major donors withdrawing from the national primary care service program leading to serious consequences for Afghani women such as women being compelled to deliver babies at home instead of hospitals increasing the risk of infections and maternal mortality. Major challenges faced by the Afghan healthcare system include the cessation of international funding due to the humanitarian crisis, the shortage of medicines, and the failure to deliver salaries to healthcare workers. According to the UNFPA, due to these challenges, more than 90% of healthcare facilities are at risk of closure, leading to an estimated 4.8 million unattended pregnancies and 51,000 maternal deaths between 2021 and 2025. To ensure such a catastrophe does not arise, the World Bank, Office for the Coordination of Humanitarian Affairs (OCHA), and UNFPA in collaboration with governments around the world have pledged aid, both monetary and in terms of equipment & resources to Afghanistan. In addition, local Afghan organizations such as the AHDS and JACK must also be supported to further their work in providing healthcare services.

I want to inform the readers about clinical quality measurement and evaluation system in Turkey. The aim of the systemis monitoring the health-cases with indicators based on process and result. The programme was first initiated in 2012. The programme is still in developing process to gain better information about clinical quality from the healthcare institutions.

In recent years, increasing physician migration from Turkey to developed countries is high on the country's agenda. This study aimed to investigate the reasons for the emergence of this mobility from Turkey to developed countries within the context of the country's socio-economic and political transformations in the health system. Interviews were conducted with twenty physicians using the in-depth interview method, one of the qualitative research methods. The study revealed that the negative effects of neoliberal policies in the field of health on the working conditions of physicians have emerged as an important reason for migration. In addition to the neoliberal transformation in health, violence and identification of physicians as targets have increased as a part of Turkey's political transformation. The weakening of the sense of belonging to the profession, the institution and the country has emerged as the main reason for migration especially among young physicians.

Benjamin J. G. Illingworth MBBS BSca,b, Timothy R. Sandhub,c BSc, Eleanor S. Smith PhDb , Claudia Lage MScb, Brónagh McCoy PhDb, Rebecca P. Lawson PhDba Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdomb Department of Psychology, University of Cambridge, Cambridge, United Kingdomc MRC Cognition and Brain Sciences Unit, Cambridge, United KingdomWord count for the body of the text: 1484Declaration of Interest: None