UNPUBLISHED GROUP RELIEFS [PORTRAIT STELAE AND GRAVE SCULPTURE] AT THE ASHMOUNIN STOREHOUSE IN MINYA

مجموعة غير منشورة للنقوش البارزة (لوحات جنائزية وشواهد قبور) بمخزن الأشمونين المتحفى بالمنيا [Ar] تتناول هذه الدراسة خمسة نماذج لشواهد قبور ولوحات جنائزية لم تنشر من قبل، ومحفوظة في مخزن الأشمونين المتحفى بالمنيا، وغير معلوم مصدرها، اثنان منهم على هيئة تماثيل بداخل ناووس أو مشكاة، وثلاثة عبارة عن تماثيل جنائزية مستقلة. يهدف هذا البحث إلى تقديم دارسة وصفية لهذه الشواهد واللوحات الجنائزية، تتبع بدراسة تحليلية مقارنة تتناول فيها مادة النحت، وتقديم رؤية واضحة للسمات الفنية لمعالجة تصوير هذه المجموعة، والأسلوب الفني المتبع في تنفيذ تماثيل المتوفين، والمتمثل في ملامح الوجه والزى والوقفة أضف إلى ذلك الكشف عن ماهية ومكانة أصحاب التماثيل، والرموز التي صورت معهم، والغرض منها. كما يعكس موضوع الدراسة صورة واضحة عن المدرسة الفنية التي أنتجت هذه المجموعة، لذا تأتى أهمية هذه الدراسة لتحديد مكان العثور عليها، ووضع تأريخ لها استنادا على كل هذه العناصر السابقة. يتضح من خلال الدراسة أن شواهد القبور، واللوحات الجنائزية مُنفذة من مواد محلية، ومصورة على الطراز الروماني، ومتأثرة بالروح والأساليب الهلّنستية، كما أنها تنتمي إلى طبقة النخبة في المجتمع المصري خلال العصر الروماني، واتضح أيضا أنها منحوتة بجودة عالية، وخلص إلى أن شواهد القبور الجنائزية موضوع الدراسة تعود إلى العصر الروماني، خاصة في الفترة الممتدة من القرن الثاني إلى بداية القرن الرابع الميلادي. أيضاً تعكس الرموز المصاحبة للتماثيل الجنائزية مدى ارتباطهم بالطقوس الجنائزية، واعتقادهم في الخلود والحماية والحياة الأبدية. [En] This study deals with five models of funeral tombstones and statues that have not been published before and are kept in the Ashmounin storehouse in Minya. Their origins are unknown. Two of them are statues inside a niche, and three of them are individual funerary statues. And provides a descriptive study of these funerary grave sculptures and statues, followed by a comparative analytical study dealing with sculpture. One goal is to provide a clear vision of artistic features. Another goal is to address the depiction of this group and its artistic style seen in its facial features, costume, and posture. Additionally, this study hopes to find the identity and status of the owners of the figurines, the symbols depicted with them, and their purpose. The subject of the study reflects a clear picture of the art school that produced the statues. The importance of this study is to determine where the statue group was found and to date it. The tombstones and funerary statues are made of local material, and depicted in the Roman style, which was influenced by the Hellenistic spirit and styles. The high quality of the carving makes it evident that the statues belonged to the elite class in Roman Egypt. The iconography included in the funerary statues reflects their connection with funeral rituals, and their belief in immortality, protection, and eternal life

UNPUBLISHED GROUP RELIEFS [PORTRAIT STELAE AND GRAVE SCULPTURE] AT THE ASHMOUNIN STOREHOUSE IN MINYA

مجموعة غير منشورة للنقوش البارزة (لوحات جنائزية وشواهد قبور) بمخزن الأشمونين المتحفى بالمنيا [AR] تتناول هذه الدراسة خمسة نماذج لشواهد قبور ولوحات جنائزية لم تنشر من قبل، ومحفوظة في مخزن الأشمونين المتحفى بالمنيا، وغير معلوم مصدرها، اثنان منهم على هيئة تماثيل بداخل ناووس أو مشكاة، وثلاثة عبارة عن تماثيل جنائزية مستقلة. يهدف هذا البحث إلى تقديم دارسة وصفية لهذه الشواهد واللوحات الجنائزية، تتبع بدراسة تحليلية مقارنة تتناول فيها مادة النحت، وتقديم رؤية واضحة للسمات الفنية لمعالجة تصوير هذه المجموعة، والأسلوب الفني المتبع في تنفيذ تماثيل المتوفين، والمتمثل في ملامح الوجه والزى والوقفة أضف إلى ذلك الكشف عن ماهية ومكانة أصحاب التماثيل، والرموز التي صورت معهم، والغرض منها. كما يعكس موضوع الدراسة صورة واضحة عن المدرسة الفنية التي أنتجت هذه المجموعة، لذا تأتى أهمية هذه الدراسة لتحديد مكان العثور عليها، ووضع تأريخ لها استنادا على كل هذه العناصر السابقة. يتضح من خلال الدراسة أن شواهد القبور، واللوحات الجنائزية مُنفذة من مواد محلية، ومصورة على الطراز الروماني، ومتأثرة بالروح والأساليب الهلّنستية، كما أنها تنتمي إلى طبقة النخبة في المجتمع المصري خلال العصر الروماني، واتضح أيضا أنها منحوتة بجودة عالية، وخلص إلى أن شواهد القبور الجنائزية موضوع الدراسة تعود إلى العصر الروماني، خاصة في الفترة الممتدة من القرن الثاني إلى بداية القرن الرابع الميلادي. أيضاً تعكس الرموز المصاحبة للتماثيل الجنائزية مدى ارتباطهم بالطقوس الجنائزية، واعتقادهم في الخلود والحماية والحياة الأبدية. [EN] This study deals with five models of funeral tombstones and statues that have not been published before and are kept in the Ashmounin storehouse in Minya. Their origins are unknown. Two of them are statues inside a niche, and three of them are individual funerary statues. And provides a descriptive study of these funerary grave sculptures and statues, followed by a comparative analytical study dealing with sculpture. One goal is to provide a clear vision of artistic features. Another goal is to address the depiction of this group and its artistic style seen in its facial features, costume, and posture. Additionally, this study hopes to find the identity and status of the owners of the figurines, the symbols depicted with them, and their purpose. The subject of the study reflects a clear picture of the art school that produced the statues. The importance of this study is to determine where the statue group was found and to date it. The tombstones and funerary statues are made of local material, and depicted in the Roman style, which was influenced by the Hellenistic spirit and styles. The high quality of the carving makes it evident that the statues belonged to the elite class in Roman Egypt. The iconography included in the funerary statues reflects their connection with funeral rituals, and their belief in immortality, protection, and eternal life

Deep Convolutional Neural Networks for Accurate Diagnosis of COVID-19 Patients Using Chest X-Ray Image Databases from Italy, Canada, and the USA

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), famously known as COVID-19, has quickly become a global pandemic. Chest X-ray (CXR) imaging has proven reliable, fast, and cost-effective for identifying COVID-19 infections, which proceeds to display atypical unilateral patchy infiltration in the lungs like typical pneumonia. We employed the deep convolutional neural network (DCNN) ResNet-34 to detect and classify CXR images from patients with COVID-19 and Viral Pneumonia and Normal Controls. Methods: We created a single database containing 781 source CXR images from four different international sub-databases: the Società Italiana di Radiologia Medica e Interventistica (SIRM), the GitHub Database, the Radiology Society of North America (RSNA), and the Kaggle Chest X-ray Database for COVID-19 (n = 240), Viral Pneumonia (n = 274), and Normal Controls (n = 267). Images were resized, normalized, without any augmentation, and arranged in m batches of 16 images before supervised training, testing, and cross-validation of the DCNN classifier. Results: The ResNet-34 had a diagnostic accuracy as of the receiver operating characteristic (ROC) curves of the true-positive rate versus the false-positive rate with the area under the curve (AUC) of 1.00, 0.99, and 0.99, for COVID-19 and Viral Pneumonia patient and Normal control CXR images; respectively. This accuracy implied identical high sensitivity and specificity values of 100, 99, and 99% for the three groups, respectively. ResNet-34 achieved a success rate of 100%, 99.6%, and 98.9% for classifying CXR images of the three groups, with an overall accuracy of 99.5% for the testing subset for diagnosis/prognosis. Conclusions: Based on this high classification precision, we believe the output activation map of the final layer of the ResNet-34 is a powerful tool for the accurate diagnosis of COVID-19 infection from CXR images

The Log-Gamma-Pareto Distribution

We study the log-gamma-Pareto distribution which includes as special cases two models such as gamma-Pareto and Pareto distributions. We demonstrate that its density function is an infinite linear combination of Pareto densities. Some mathematical properties of the new distribution are derived, such as moments, distribution of the order statistics, Shannon and Renyi entropies and maximum entropy characterization. We use maximum likelihood estimation to estimate model parameters and an application to a real data set illustrates its potentiality. We generate random numbers from the cdf of the distribution and obtain the mean, bias, mean square error, standard error, Kurtosis and Skewness for each parameter

A framework to estimate the cost of No-Fault Found events

The article investigates a generic framework to estimate maintenance costs attributed to the No Fault Found (NFF) phenomenon. Such overhead costs are particularly difficult to quantify due to potentially serviceable equipment being returned for repair. Other factors, such as a reduction in the availability of the system, compromising reliability of high value assets, and logistical factors, can all contribute to the cost of resolving an unknown fault. Here we apply the soft systems methodology to capture the critical cost drivers of NFF across the supply chain and build a framework to estimate the cost of NFF. We use a multi-method design including an online survey, workshops and semi-structured interviews to study NFF related cost practices based on information from 12 key participants across 7 UK organisations. The study identifies the major NFF cost drivers across the supply chain (e.g. transportation), the OEM (e.g. inventory) and the customer (e.g. lost man hours). An agent based model is used to evaluate the impact of these cost drivers on the overall NFF cost. The analysis shows how the most appropriate drivers can be selected to represent the cumulative costs due to NFF events and their impacts across the supply network. From the academic perspective, the generic framework for NFF cost estimation demonstrates how qualitative and quantitative information can be used together to achieve maintenance objectives. From a practical perspective, by applying the framework on one component, an organisation has the liberty to analyse the cost of NFF for that particular unit only

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe