UNIPOLARITY, MULTIPOLARITY AND BIPOLAR COALITIONS. XXI CENTURY

The paper considers the consequences of one of the topical aspects of the complex and, according to some estimates, catastrophic state of the modern world – the collision of conflicting trends in globalization and sovereignty. The downward trend of globalization (not to be confused with internationalization) is observed after the global financial and economic crisis of 2008–2009. It has intensified under the influence of the covid pandemic and sanctions restrictions. Sovereignty trends, including those influenced by these factors have, on the contrary, an upward trend. In the 2020s, the contradictory tendencies of globalization and sovereignty increased the threat of world chaos. The resolution of contradictory tendencies and the formation of a new world order is possible on the basis of one of the models of a (new) unipolar, multipolar or bipolar world. The paper compares the perspectives of each of these actively discussed models of world development. On the basis of the analysis carried out, based on the theory of institutional X-Y matrices and empirical data, the greatest probability is the formation of a bipolar world. Its peculiarity, however, lies not in the crystallization of two "poles of power” in the form of rival states, but in the institutionalization of similar powerful international bipolar coalitions. Their composition was predicted by the author in the book "Institutional Matrices and the Development of Russia…” (Kirdina, 2014) and is confirmed by rесent practice. © 2022, Russian Academy of Sciences. All rights reserved.

Inferior altitudinal visual loss and mask-wearing practices: A case series.

Face mask-wearing practices and their impact on the visual field bear particular importance in the coronavirus disease 2019 (COVID-19) pandemic era. This case series examines 10 participants with no history of ocular impairment or visual field defects who underwent age-corrected visual field testing in both eyes with different types of face masks. Wearing duckbill N95 masks was consistently associated with increased accuracy errors in the inferior altitudinal visual field when compared to wearing surgical masks or no masks. These findings support public health guidance that has previously attributed the risks of falls and accidents to face mask wearing.

Unipolarity, Multipolarity and Bipolar Coalitions. XXI Century

"The paper considers the consequences of one of the topical aspects of the complex and, according to some estimates, catastrophic state of the modern world – the collision of conflicting trends in globalization and sovereignty. The downward trend of globalization (not to be confused with internationalization) is observed after the global financial and economic crisis of 2008–2009. It has intensified under the influence of the covid pandemic and sanctions restrictions. Sovereignty trends, including those influenced by these factors have, on the contrary, an upward trend. In the 2020s, the contradictory tendencies of globalization and sovereignty increased the threat of world chaos. The resolution of contradictory tendencies and the formation of a new world order is possible on the basis of one of the models of a (new) unipolar, multipolar or bipolar world. The paper compares the perspectives of each of these actively discussed models of world development. On the basis of the analysis carried out, based on the theory of institutional X-Y matrices and empirical data, the greatest probability is the formation of a bipolar world. Its peculiarity, however, lies not in the crystallization of two ""poles of power"" in the form of rival states, but in the institutionalization of similar powerful international bipolar coalitions. Their composition was predicted by the author in the book ""Institutional Matrices and the Development of Russia…"" (Kirdina, 2014) and is confirmed by rесent practice.Alternate :В статье рассмотрены последствия одного из актуальных аспектов сложного и по некоторым оценкам катастрофического состояния современного мира – столкновения противоречивых тенденций глобализации и суверенизации. Нисходящий тренд глобализации (не путать с интернационализацией) наблюдается после мирового финансово-экономического кризиса 2008–2009 гг. Он усилился под воздействием ковид-пандемии и санкционных рестрикций. Тенденции суверенизации, в том числе под влиянием данных факторов, наоборот, имеют восходящий тренд. В 2020-е гг. противоречивые тенденции глобализации и суверенизации обострили угрозу мирового хаоса. Разрешение противоречивых тенденций и формирование нового мирового порядка возможны на основе одной из моделей (нового) однополярного, многополярного или биполярного мира. В статье сопоставляются перспективы каждой из этих активно обсуждаемых моделей мирового развития. На основе проведенного анализа, опирающегося на теорию институциональных Х-Y-матриц и эмпирические данные, обосновывается наибольшая вероятность становления биполярного мира. Его особенность, однако, состоит не в кристаллизация двух «полюсов силы» в виде соперничающих государств, а в институционализации равно могущественных межгосударственных биполярных коалиций. Их состав был спрогнозирован автором ранее (Кирдина, 2014) и подтверждается современной практикой."

Adapting the investigation of patients on urgent suspected cancer pathway with lower gastrointestinal symptoms across Wales during COVID-19.

INTRODUCTION: The COVID-19 pandemic necessitated the introduction of revised diagnostic pathways for assessing urgent suspected cancer (USC) referrals. Combinations of faecal immunochemical testing (FIT) and minimal preparation computed tomography (CT) scans (MPCT) were used to manage referrals and prioritise access to clinical services or invasive tests. The effectiveness of these pathways across Wales is evaluated in this study. METHODS: All consecutive patients referred from primary care on the USC pathway between 15 March and 15 June 2020 were included to reflect the effect of full lockdown measures. Data collected included demographics, presenting symptom(s), investigations and timelines and patient outcomes up to 90 days following initial referral. RESULTS: A total of 1,050 patients across eight sites in Wales were included. Of these 1,050 patients, 52.6% were female with median age 68 (21-97) years; 50.5% had first-line clinical review, of which 61.1% were virtual consultations; 49.5% had primary investigations; 26.7% of patients had FIT and 13.1% had MPCT. COVID-response pathways achieved a 29.9% reduction in use of colonoscopy as first-line investigation and 79% of patients avoided face-to-face consultations altogether during this first wave of the pandemic. Overall, 6.8% of USC referrals were diagnosed with colorectal cancer (CRC). Median timescale from diagnosis to treatment for CRC was 65 (4-175) days. The negative predictive value (NPV) for FIT in this cohort was 99.6%. MPCT as the first modality had a NPV of 99.2%. CONCLUSION: A modified investigation pathway helped maintain cancer diagnosis rates during the pandemic with improved resource utilisation to that used prepandemic.

SARS-CoV-2 infection in pediatric oncology patients: A single institution experience

Purpose of Study The novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has a predilection for severe outcomes in adults. Immunocompromised adults are at higher risk of severe disease. The pediatric population has experienced lower rates of morbidity and mortality. However, recent data shows that pediatric patients with cancer may also be at higher risk of severe disease, as seen in the adult population. This descriptive study will help assess the effect of SARS-CoV-2 infection on pediatric patients with oncologic disorders. Methods Used This IRB-approved retrospective study was conducted between March 2020 to August 2021. Patients between the ages of 0-21 years with an oncologic disorder who tested positive for SARS-CoV-2 were included. Laboratory evaluation was included if within 2 weeks of initial infection with 3 patients being excluded due to no labs available but still included in the clinical analysis. Summary of Results Thirty-one oncology patients with SARSCoV- 2 infection were identified. Median age of 9 years (range 1-20). Fifteen females and 16 males. Diagnoses included were acute leukemia (15), lymphoma (4), CNS tumor (8), and solid tumor (4). Fifty-five percent of patients were asymptomatic and had been tested due to a scheduled hospital admission, procedure requiring sedation, or known exposure to SARSCoV- 2. Forty-eight percent of patients were obese or overweight. Most common symptoms included fever (26%), congestion (19%), and cough (26%). Only 6% of patients complained of loss of taste. No patients complained of loss of smell. Twenty-nine percent of patients had moderate SARS-CoV- 2 disease severity, requiring inpatient management for symptoms without ICU-level care. Three patients developed pneumonia, 2 requiring supplemental oxygen, but none needed ICU-level care. Of the four patients who had completed therapy, one was asymptomatic and the other 3 had mild disease, requiring symptomatic care at home. One patient had been fully vaccinated against SARS-CoV-2 with a mild infection occurring 2 months after the second vaccine. Median laboratory values for patients who had SARSCoV- 2 mild/moderate disease compared to asymptomatic patients included hemoglobin 10.4 g/dL and 11.5 g/dL, platelet 185,000and 198,000, absolute lymphocyte count 820 and 1465, absolute neutrophil count 1145 and 1780, respectively. No statistically significant difference was found. Conclusions Pediatric oncology patients at our institution had a more benign course with SARS-CoV-2 when compared to national and international reports. Although almost half of our patients were obese or overweight, none had severe disease. Loss of taste and/or smell was uncommon in our patients. As data is rapidly growing, it is important to evaluate risk factors, outcomes, and natural history in this vulnerable population in order to develop management guidelines.

The use of Faecal Immunochemical Testing (FIT) and Minimal Preparation Computed Tomography (MPCT) during COVID-19 for Urgent Suspected Cancer (USC) referrals in patients with lower gastro-intestinal symptoms

Introduction: Revised patient pathways incorporating combinations of FIT and MPCT were introduced to triage USC referrals during the COVID-19 pandemic to replace straight-to- test colonoscopy. This study aims to evaluate the effectiveness of a secondary care diagnostic pathway improvement initiative for colorectal cancer referrals. Method: All consecutive patients referred from primary care on the USC pathway between 15th March -15th June 2020 were included to reflect the effect of full lockdown measures. Data collected included demographics, presenting symptom(s), investigations, timelines and patient outcomes up to 90 days following initial referral. Results: 816 patients across 8 sites in Wales were included in this initial analysis. 52.7% of patients were female with median age 69 (21 -97) years. Of the 50.7% who had first-line clinical review, 70.5% were virtual consultations. 49.3% had primary investigations, with FIT in 31% of patients and MPCT in 18.3%. This was compliant with locally agreed pathways for 77.3% of referrals. COVID-response pathways achieved a 28.5% reduction in use of colonoscopy as first-line investigation and 84.3% of patients avoided face-to- face consultations during this first wave of the pandemic. Referred patients required a median of 1 secondary care investigation (0 -6). Overall, 5.6% of USC referrals were diagnosed with CRC, similar to pre-pandemic rates. Median timescale from diagnosis to treatment for CRC was 82 (4 -175) days. The NPV for FIT in this cohort was 99.5%. MPCT as the first modality had a NPV of 99%. Conclusion: A modified investigation pathway maintained cancer diagnosis during the pandemic with improved resource utilisation to that used previously.

Where have all the appendicectomies gone?

INTRODUCTION: The COVID-19 pandemic stimulated a national lockdown in the UK. The public were advised to avoid unnecessary hospital attendances and health professionals were advised to avoid aerosol-generating procedures wherever possible. The authors hypothesised that these measures would result in a reduction in the number of patients presenting to hospital with acute appendicitis and alter treatment choices. METHODS: A multicentred, prospective observational study was undertaken during April 2020 to identify adults treated for acute appendicitis. Searches of operative and radiological records were performed to identify patients treated during April 2018 and April 2019 for comparison. RESULTS: A total of 190 patients were treated for acute appendicitis pre-lockdown compared with 64 patients treated during lockdown. Patients treated during the pandemic were more likely to have a higher American Society of Anesthesiology (ASA) score (p = 0.049) and to have delayed their presentation to hospital (2 versus 3 days, p = 0.03). During the lockdown, the use of computed tomography (CT) increased from 36.3% to 85.9% (p < 0.001), the use of an antibiotic-only approach increased from 6.2% to 40.6% (p < 0.001) and the rate of laparoscopic appendicectomy reduced from 85.3% to 17.2% (p < 0.001). The negative appendicectomy rate decreased from 21.7% to 7.1% during lockdown (p < 0.001). CONCLUSIONS: The COVID-19 lockdown was associated with a decreased incidence of acute appendicitis and a significant shift in the management approach. The increased use of CT allows the identification of simple appendicitis for conservative treatment and decreases the negative appendicectomy rate.

Kidney supportive care (KSC): Evaluating need in a time of crisis

Aim: To evaluate how the COVID-19 pandemic affected kidney supportive care (KSC) referrals and care. Background: Our health service re-designed delivery of the KSC service in response to COVID-19, including transitioning to a telehealth model and prioritising advance care planning (ACP). Methods: Activity was audited over two three-month periods between 1 October-31 December 2019 (PRE-COVID-19) and 11 March-11 June 2020 (POST-COVID-19). Baseline demographics (age, gender), severity of kidney disease (eGFR, kidney replacement therapy [KRT]), patient functionality (resource utilization groups [RUG], Australian Karnofsky performance score [AKPS]), and reason for referral (advance care planning [ACP], decision making, symptom management, conservative management) were extracted from clinical records. Statistical analysis was performed in SPSS and included Chi square, independent T and Mann-Whitney U tests as appropriate. Results: Pre-COVID-19 there were 29 referrals, with median age 73 (IQR = 17), eGFR 13 (IQR = 7), 27.6% receiving KRT, mean RUG 5.76 (SD = 2.3) and AKPS 56.52 (SD = 12.03). There were 54 POST-COVID-19 referrals, median age 75 (IQR = 12.75), eGFR 14 (IQR = 8.75), 35.19% KRT, mean RUG 5.22 (SD = 2.7) and AKPS 60 (SD = 13.2). 92 patients were seen pre-COVID-19 and 135 POST-COVID-19. PRE vs POST-COVID-19 results showed that 44.8% vs 63% (p = 0.175) were referred for ACP, 13.8% vs 5.6% for decision making (p = 0.382), 31% vs 18.5% for symptom management (p = 0.308). Conservative management was indicated as the reason for referral, more frequently, pre-COVID compared to post-COVID (69% vs 29.6%, p = 0.001). Conclusions: Meeting the needs of this vulnerable group of patients was a priority of the health service as evident in the increased activity through the clinic. The types of activities shifted, with a focus on ACP via a telehealth model, without a significant change in the characteristics of patients.