Affine hom-complexes

For two general polytopal complexes the set of face-wise affine maps between them is shown to be a polytopal complex in an algorithmic way. The resulting algorithm for the affine hom-complex is analyzed in detail. There is also a natural tensor product of polytopal complexes, which is the left adjoint functor for Hom. This extends the corresponding facts from single polytopes, systematic study of which was initiated in [6,12]. Explicit examples of computations of the resulting structures are included. In the special case of simplicial complexes, the affine hom-complex is a functorial subcomplex of Kozlov's combinatorial hom-complex [14], which generalizes Lovasz' well-known construction [15] for graphs.Comment: final version, to appear in Portugaliae Mathematic

Effect of Age at Diagnosis on Cervical Cancer Patient Prognoses in Georgia

The current incidence of cervical cancer varies around 17.0/100,000 women per year. The study aims to describe the effect of age at diagnosis on CC patient prognosis in Georgia. Methods. Univariable and Multivariable survival analysis using Cox’s regression model was constructed. All women aged ≤80 years,  diagnosed with invasive CC (ICD10-site code C53) from 2015 to 2019,  were eligible for inclusion in the analysis. During analysis a hazard (mortality) ratio for the patients, who were diagnosed at different ages was estimated. Survival period was determined from the date of diagnosis until the date of death or the date of last follow up visit. High risk of death was defined as a mortality of CC patients whose survival period was less than 5 years.The level of statistical significance of the study findings is estimated by using p-value andthe 95% of confidence interval (95%CI). A p value < 0.05 was considered as statistically significant. In estimation of hazard ratio, the patients under 41 years were selected as a reference group. Data was analyzed using Statistical Package of SPSS version 23. Results.Totally 1646 CC patients were enrolled in the study. The median age at diagnosis was 54years and age range was 25 - 80 years. Univariable statistical analysis has revealed that cancer diagnosed over 60 years of age had a higher death hazard (HR=1.80, p<0.001), compared to cancer detected under 60 years (HR=3.30, p<0.001). Multivariable statistical analysis has detected that stage and age at diagnosis are independent, statistically significant predictors for high mortality in patients diagnosed with cervical cancer, while the role of histological grade has not been revealed. In addition, older age generally is related to a high prevalence of comorbidities. The reasons for the unfavourable cervical cancer prognosis in older patients that was detected  during statistical analysis might be explained by tumor stage at diagnoses and with higher ratesof comorbidity among the elderly. Conclusions: Finally, our study results are in concordance with numerous studies, which confirm that the age of patients at the moment of diagnosis is an independent predictor for cervical cancer early mortality

Controllability of 2D Euler and Navier-Stokes equations by degenerate forcing

We study controllability issues for the 2D Euler and Navier- Stokes (NS) systems under periodic boundary conditions. These systems describe motion of homogeneous ideal or viscous incompressible fluid on a two-dimensional torus T^2. We assume the system to be controlled by a degenerate forcing applied to fixed number of modes. In our previous work [3, 5, 4] we studied global controllability by means of degenerate forcing for Navier-Stokes (NS) systems with nonvanishing viscosity (\nu > 0). Methods of dfferential geometric/Lie algebraic control theory have been used for that study. In [3] criteria for global controllability of nite-dimensional Galerkin approximations of 2D and 3D NS systems have been established. It is almost immediate to see that these criteria are also valid for the Galerkin approximations of the Euler systems. In [5, 4] we established a much more intricate suf- cient criteria for global controllability in finite-dimensional observed component and for L2-approximate controllability for 2D NS system. The justication of these criteria was based on a Lyapunov-Schmidt reduction to a finite-dimensional system. Possibility of such a reduction rested upon the dissipativity of NS system, and hence the previous approach can not be adapted for Euler system. In the present contribution we improve and extend the controllability results in several aspects: 1) we obtain a stronger sufficient condition for controllability of 2D NS system in an observed component and for L2- approximate controllability; 2) we prove that these criteria are valid for the case of ideal incompressible uid (\nu = 0); 3) we study solid controllability in projection on any finite-dimensional subspace and establish a sufficient criterion for such controllability

Evolution of the Greater Caucasus Basement and Formation of the Main Caucasus Thrust, Georgia

Along the northern margin of the Arabia‐Eurasia collision zone in the western Greater Caucasus, the Main Caucasus Thrust (MCT) juxtaposes Paleozoic crystalline basement to the north against Mesozoic metasedimentary and volcaniclastic rocks to the south. The MCT is commonly assumed to be the trace of an active plate‐boundary scale structure that accommodates Arabia‐Eurasia convergence, but field data supporting this interpretation are equivocal. Here we investigate the deformation history of the rocks juxtaposed across the MCT in Georgia using field observations, microstructural analysis, U‐Pb and 40Ar/39Ar geochronology, and 40Ar/39Ar and (U‐Th)/He thermochronology. Zircon U‐Pb analyses show that Greater Caucasus crystalline rocks formed in the Early Paleozoic on the margin of Gondwana. Low‐pressure/temperature amphibolite‐facies metamorphism of these metasedimentary rocks and associated plutonism likely took place during Carboniferous accretion onto the Laurussian margin, as indicated by igneous and metamorphic zircon U‐Pb ages of ~330–310 Ma. 40Ar/39Ar ages of ~190–135 Ma from muscovite in a greenschist‐facies shear zone indicate that the MCT likely developed during Mesozoic inversion and/or rifting of the Caucasus Basin. A Mesozoic 40Ar/39Ar biotite age with release spectra indicating partial resetting and Cenozoic (<40 Ma) apatite and zircon (U‐Th)/He ages imply at least ~5–8 km of Greater Caucasus basement exhumation since ~10 Ma in response to Arabia‐Eurasia collision. Cenozoic reactivation of the MCT may have accommodated a fraction of this exhumation. However, Cenozoic zircon (U‐Th)/He ages in both the hanging wall and footwall of the MCT require partitioning a substantial component of this deformation onto structures to the south.Plain Language SummaryCollisions between continents cause deformation of the Earth’s crust and the uplift of large mountain ranges like the Himalayas. Large faults often form to accommodate this deformation and may help bring rocks once buried at great depths up to the surface of the Earth. The Greater Caucasus Mountains form the northernmost part of a zone of deformation due to the ongoing collision between the Arabian and Eurasian continents. The Main Caucasus Thrust (MCT) is a fault juxtaposing old igneous and metamorphic (crystalline) rocks against younger rocks that has often been assumed to be a major means of accommodating Arabia‐Eurasia collision. This study examines the history of rocks along the MCT with a combination of field work, study of microscopic deformation in rocks, and dating of rock formation and cooling. The crystalline rocks were added to the margins of present‐day Eurasia about 330–310 million years ago, and the MCT first formed about 190–135 million years ago. The MCT is likely at most one of many structures accommodating present‐day Arabia‐Eurasia collision.Key PointsAmphibolite‐facies metamorphism and plutonism in the Greater Caucasus basement took place ~330–310 MaThe Main Caucasus Thrust formed as a greenschist‐facies shear zone during Caucasus Basin inversion and/or rifting (~190–135 Ma)The Main Caucasus Thrust may have helped facilitate a portion of at least 5–8 km of basement exhumation during Arabia‐Eurasia collisionPeer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154626/1/tect21292-sup-0002-2019TC005828-ts01.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154626/2/tect21292-sup-0006-2019TC005828-ts05.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154626/3/tect21292_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154626/4/tect21292-sup-0003-2019TC005828-ts02.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154626/5/tect21292-sup-0005-2019TC005828-ts04.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154626/6/tect21292.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154626/7/tect21292-sup-0004-2019TC005828-ts03.pd

The global campaign to eliminate HBV and HCV infection: International Viral Hepatitis Elimination Meeting and core indicators for development towards the 2030 elimination goals

Hepatitis B virus (HBV) and hepatitis C virus (HCV) affect more than 320 million people worldwide, which is more than HIV, tuberculosis (TB) and malaria combined. Elimination of HBV and HCV will, therefore, produce substantial public health and economic benefits and, most importantly, the prevention of 1.2 million deaths per year. In 2016, member states of the World Health Assembly unanimously adopted a resolution declaring that viral hepatitis should be eliminated by 2030. Currently, few countries have elimination programmes in place and even though the tools to achieve elimination are available, the right resources, commitments and allocations are lacking. During the fifth International Viral Hepatitis Elimination Meeting (IVHEM), 7–8 December 2018, Amsterdam, the Netherlands, an expert panel of clinicians, virologists and public health specialists discussed the current status of viral hepatitis elimination programmes across multiple countries, challenges in achieving elimination and the core indicators for monitoring progress, approaches that have failed and successful elimination plans

Massive migration from the steppe is a source for Indo-European languages in Europe

We generated genome-wide data from 69 Europeans who lived between 8,000-3,000 years ago by enriching ancient DNA libraries for a target set of almost four hundred thousand polymorphisms. Enrichment of these positions decreases the sequencing required for genome-wide ancient DNA analysis by a median of around 250-fold, allowing us to study an order of magnitude more individuals than previous studies and to obtain new insights about the past. We show that the populations of western and far eastern Europe followed opposite trajectories between 8,000-5,000 years ago. At the beginning of the Neolithic period in Europe, ~8,000-7,000 years ago, closely related groups of early farmers appeared in Germany, Hungary, and Spain, different from indigenous hunter-gatherers, whereas Russia was inhabited by a distinctive population of hunter-gatherers with high affinity to a ~24,000 year old Siberian6 . By ~6,000-5,000 years ago, a resurgence of hunter-gatherer ancestry had occurred throughout much of Europe, but in Russia, the Yamnaya steppe herders of this time were descended not only from the preceding eastern European hunter-gatherers, but from a population of Near Eastern ancestry. Western and Eastern Europe came into contact ~4,500 years ago, as the Late Neolithic Corded Ware people from Germany traced ~3/4 of their ancestry to the Yamnaya, documenting a massive migration into the heartland of Europe from its eastern periphery. This steppe ancestry persisted in all sampled central Europeans until at least ~3,000 years ago, and is ubiquitous in present-day Europeans. These results provide support for the theory of a steppe origin of at least some of the Indo-European languages of Europe

Human resources for health challenges of public health system reform in Georgia

<p>Abstract</p> <p>Background</p> <p>Human resources (HR) are one of the most important components determining performance of public health system. The aim of this study was to assess adequacy of HR of local public health agencies to meet the needs emerging from health care reforms in Georgia.</p> <p>Methods</p> <p>We used the Human Resources for Health Action Framework, which includes six components: HR management, policy, finance, education, partnerships and leadership. The study employed: (a) quantitative methods: from September to November 2004, 30 randomly selected district Centers of Public Health (CPH) were surveyed through face-to-face interviews with the CPH director and one public health worker randomly selected from all professional staff; and (b) qualitative methods: in November 2004, Focus Group Discussions (FGD) were held among 3 groups: a) 12 district public health professionals, b) 11 directors of district public health centers, and c) 10 policy makers at central level.</p> <p>Results</p> <p>There was an unequal distribution of public health workers across selected institutions, with lack of professionals in remote rural district centers and overstaffing in urban centers. Survey respondents disagreed or were uncertain that public health workers possess adequate skills and knowledge necessary for delivery of public health programs. FGDs shed additional light on the survey findings that there is no clear vision and plans on HR development. Limited budget, poor planning, and ignorance from the local government were mentioned as main reasons for inadequate staffing. FGD participants were concerned with lack of good training institutions and training programs, lack of adequate legislation for HR issues, and lack of necessary resources for HR development from the government.</p> <p>Conclusion</p> <p>After ten years of public health system reforms in Georgia, the public health workforce still has major problems such as irrational distribution and inadequate knowledge and skills. There is an urgent need for re-training and training programs and development of conducive policy environment with sufficient resources to address these problems and assure adequate functionality of public health programs.</p

Human resource management in the Georgian National Immunization Program: a baseline assessment

Background: Georgia's health care system underwent dramatic reform after gaining independence in 1991. The decentralization of the health care system was one of the core elements of health care reform but reports suggest that human resource management issues were overlooked. The Georgian national immunization program was affected by these reforms and is not functioning at optimum levels. This paper describes the state of human resource management practices within the Georgian national immunization program in late 2004. Methods: Thirty districts were selected for the study. Within these districts, 392 providers and thirty immunization managers participated in the study. Survey questionnaires were administered through face-to-face interviews to immunization managers and a mail survey was administered to immunization providers. Qualitative data collection involved four focus groups. Analysis of variance (ANOVA) and Chi-square tests were used to test for differences between groups for continuous and categorical variables. Content analysis identified main themes within the focus groups. Results: Weak administrative links exist between the Centres of Public Health (CPH) and Primary Health Care (PHC) health facilities. There is a lack of clear management guidelines and only 49.6% of all health providers had written job descriptions. A common concern among all respondents was the extremely inadequate salary. Managers cited lack of authority and poor knowledge and skills in human resource management. Lack of resources and infrastructure were identified as major barriers to improving immunization. Conclusion: Our study found that the National Immunization Program in Georgia was characterized by weak organizational structure and processes and a lack of knowledge and skills in management and supervision, especially at peripheral levels. The development of the skills and processes of a well-managed workforce may help improve immunization rates, facilitate successful implementation of remaining health care reforms and is an overall, wise investment. However, reforms at strategic policy levels and across sectors will be necessary to address the systemic financial and health system constraints impeding the performance of the immunization program and the health care system as a whole

The role of supportive supervision on immunization program outcome - a randomized field trial from Georgia

<p>Abstract</p> <p>Background</p> <p>One of the most common barriers to improving immunization coverage rates is human resources and its management. In the Republic of Georgia, a country where widespread health care reforms have taken place over the last decade, an intervention was recently implemented to strengthen performance of immunization programs. A range of measures were taken to ensure that immunization managers carry out their activities effectively through direct, personal contact on a regular basis to guide, support and assist designated health care facility staff to become more competent in their immunization work. The aim of this study was to document the effects of "supportive" supervision on the performance of the immunization program at the district(s) level in Georgia.</p> <p>Methods</p> <p>A pre-post experimental research design is used for the quantitative evaluation. Data come from baseline and follow-up surveys of health care providers and immunization managers in 15 intervention and 15 control districts. These data were supplemented by focus group discussions amongst Centre of Public Health and health facility staff.</p> <p>Results</p> <p>The results of the study suggest that the intervention package resulted in a number of expected improvements. Among immunization managers, the intervention independently contributed to improved knowledge of supportive supervision, and helped remove self-perceived barriers to supportive supervision such as availability of resources to supervisors, lack of a clear format for providing supportive supervision, and lack of recognition among providers of the importance of supportive supervision. The intervention independently contributed to relative improvements in district-level service delivery outcomes such as vaccine wastage factors and the DPT-3 immunization coverage rate. The clear positive improvement in all service delivery outcomes across both the intervention and control districts can be attributed to an overall improvement in the Georgian population's access to health care.</p> <p>Conclusion</p> <p>Provider-based interventions such as supportive supervision can have independent positive effects on immunization program indicators. Thus, it is recommended to implement supportive supervision within the framework of national immunization programs in Georgia and other countries in transition with similar institutional arrangements for health services organization.</p> <p>Abstract in Russian</p> <p>See the full article online for a translation of this abstract in Russian.</p