Journal articles on the topic 'Egyptian Old Kingdom – statistical analysis'

On the basis of extensive material obtained during the work of the Russian archaeological mission, a generalization of the structural design of doors in Ancient Egyptian rock-cut tombs on the Eastern Plateau of Giza was carried out. The analysis showed that the size and structural design of the doors are directly related to the time of the chapel construction, the wealth of the tomb owner and natural or artificial features of the rocky area. Thus, the first rock-cut tombs whose owners had a high social status, which began to be built from the middle of the V dynasty on the eastern edge of the Eastern Plateau, are distinguished not only by their large size and extensive pictorial program of chapel decoration, but also by wide passages, inserted drums of better stone and well executed door fastening places. While towards the end of the Old Kingdom, when the Necropolis became compact and generally impoverished, there was a marked tendency not only to reduce the size of the passages to the chapels, but also to simplify the door arrangement and even to abandon the doors in most of the tombs. The development of gentle rocky areas and areas of poor rock quality in V–VI dynasties, leads to the appearance of steps to descend into the chapel, open courtyards and reduced dimensions of the passages to maintain their strength. Statistical analysis of the width of the passages and drums height in the chapels of the 72 currently available rock-cut tombs has demonstrated the existence of stable dimensional standards at the beginning of the development of the rock massif (c. mid V dynasty). For example, the tombs that appeared first in the tomb groups had an opening width of 10 or 12 ancient Egyptian palms (76–80 or 90–98 cm) and a drum height of 4 or 7 palms (30 or 52 cm). But towards the end of the Old Kingdom the width of the passages is reduced to about 8 palms (about 60 cm) and the height of the drums above the passages to 17 cm, and in many cases they disappear from the decoration of the entrances.

The author of the paper aims at scrutinising the linguistic image of the Egyptian pharaoh in the so-called Pyramid Texts. Was the Egyptian ruler perceived as a human representative of the god on Earth or rather was he a or the god himself? Special emphasis will be put on names and epithets of the King when described or referred to in religious texts of the Old Kingdom. This study is planned as a part of a future research project on picturing the pharaoh through language in religious and royal texts from the beginning of the Old Kingdom till the end of the New Kingdom, and realised in cooperation with Dr. Andrzej Ćwiek and Jadwiga Iwaszczuk.Furthermore, the paper is also a presentation of use of ethnolinguistic methods in Egyptology. Using scholarly methods of the ‘linguistic worldview’ research project in which the present author participates, it is intended to study selected ancient Egyptian concepts. Although language analysis as well as widely understood and studied ‘life context’ of ancient religious notions let us only a textual and linguistic reconstruction of the world presented, concurrently, helps us understand better the Egyptian religious way of description and thinking.

Depictions of the natural world are an intrinsic feature of Egyptian visual culture, with the vast array of imagery documenting animals a testimony to the fundamental role they played. Despite the significance of animals in Egypt, an anthropocentric bias still exists in research on the methods used by practitioners during initial scene composition. To help bridge the divide, the author herein undertook an investigation to determine if proportional guides were in place when rendering animal figures in ancient Egyptian elite tomb imagery of the Old and Middle Kingdoms. A notable outcome of the proportional analysis was the identification of two distinct body-types for domestic cattle (Bos taurus taurus). The aim of the current paper is to further examine these proportional differences to explore if variations in physique (namely the distance between the chest floor and withers) were rendered by Egyptian practitioners to reflect the conditions in which they appeared by considering two overarching factors: (1) biological factors and (2) contextual factors. As such, the study will employ proportional analysis to challenge the prevailing perspective of a deregulated approach when illustrating fauna in elite tomb imagery, highlighting the significance of animals within ancient Egypt.

A recently discovered Egyptian wooden statue of King Djedefre was studied together with some surrounding burial soil samples for assessing the statue biodeterioration. The wooden morphological characterisation identified the hardwood Acacia nilotica as the wood type. X-ray diffraction, micro-FT-IR spectroscopy, and scanning electron microscopy with an X-ray spectrometer were used to evaluate the wood deterioration degree and the soil contribution in wood biodeterioration. Microbiological analyses (fluorescent in situ hybridisation and polymerase chain reaction) were also performed to detect the microbial attack on the statue. The prolonged interaction of the statue with the burial environment caused a strong wood decay due to biotic (fungi and bacteria) and abiotic factors (e.g., humidity fluctuations of the burial environment), which caused the severe cracking and collapsing of the wood structures. The analyses of the burial soil mineral composition were relevant for obtaining an overall picture of the statue deterioration. The results are useful for planning the right conservation procedures for this very particular and important wooden statue. Furthermore, analysis of the woody cell wall will help in the selection of appropriate consolidation and recovery treatments. Because the statue is a unique single piece of wood, and the morphological observations indicated that it is a bald woman in a sitting position, this statue will provide new and interesting knowledge of Egyptian culture.

“Multimodal graphic communication in Ancient Egypt: A method for analysis”: This article presents a method to analyse Hieroglyphic-Egyptian artefacts based on the semiotic approach of multimodality. In a first step, the theoretical background of multimodality research is given and its methodological application to Hieroglyphic-Egyptian text-image-compositions is discussed. In a second step, the method is illustrated analysing a relief from an Old Kingdom mastaba in Giza – the will of Wep-em-nefert (G8882). In a third step, some graphic techniques for information structuring are compared to similar techniques that can be found in Franco-Belgian comics. In indenting semiotic methods of multimodality research with Egyptology, this article presents a new perspective for the investigation of Hieroglyphic-Egyptian artefacts, which opens new grounds for both research areas and for interdisciplinary dialog.

Summary The present study aims to outline new, more adjusted approaches of research addressing social complexity of past societies. In doing so, we use varied evidence to detect major ‘leap events’ in the history of ancient Egypt which were reflected by the state administration and its fluctuating complexity. The archaeological and inscriptional evidence shows that crucial changes in history had a non-linear, punctuated character. To reveal their true character, newly developed mathematical models have been applied. The analyses of early complex civilisations have made a noticeable progress recently. The current scholarship pays significant attention to a processual approach, description of the dynamics and its interpretation against the specific background formed by varied datasets originating from disciplines such as archaeology, history, art history, philology or environmental sciences to name but a few of the most relevant ones. Within this context, Old Kingdom Egypt evidence is reassessed using specific methods of analysis and interpretation. The ancient Egyptian Old Kingdom (2592–2120 BC), one of the earliest territorial states on this planet, is still frequently considered to be a homogenous continuum of isolated historical events manifested in various forms of architecture, art or religion. Some recent studies applied to its study put emphasis on a non-linear, ‘punctuated approach’ which appears to provide some new important perspectives on this traditional problem. The application of modern mathematical methods based on Hidden Markov Models and Social Network Analysis significantly changes this view. These methods have the potential to detail a vivid, heterogenous process of historical progress as a punctuated equilibria model, as a non-linear system with changing dynamics of its development in time. In this process, human agency, the rise and fluctuation of complexity and particular strategies of different social groups played significant roles and can be detected with the help of impartial approaches. The emerging picture can be used not only to describe the evolution of a past society but also for comparative purposes when studying the dynamics of past or present societies.

The present study concerns a longue durée evolution of the ancient Egyptian Snw.ty from the time of its foundation during the Old Kingdom to the end of the Middle Kingdom (ca 2600–1650 BC). During this time, Snw.ty was the apex of the royal grain management as an important royal tool and intermediary between the producers and receivers of the grain. The objective of this study is to determine how Snw.ty was used during this time and how its operations transformed with respect to changing royal administration and policies. The analysis is based on observation of term’s use transformations which might be indicative of its changing sense, as found in written documents referring to both Snw.ty and related Snw.wt installations.

The detection of falciparum malaria in ancient Egyptian remains had been performed by many authors using several methodologies including the use of rapid diagnostic tests. Through the immunochromatographic analysis of bony specimens from Giza skeletal collection dated to Old Kingdom, we provide first evidence of non-falciparum malaria in Ancient Egypt. The histidine-rich protein-2 (HRP2) specific toPlasmodium falciparumwas absent in 100% of examined samples, while aldolase, common to the four types of plasmodial pathogens causing human malaria, was detected in 56% of individuals with no significant difference between the two tested social groups: high officials (HO) and workers (W). It is suggested that the main risk factor was the presence of residences near natural and artificial waterways, which allowed prolonged contact between the vector and human host.

The work aims to study the manufacturing technique, microstructure features, and morphology and mechanism corrosion of a hammered copper basin belonging to one of the early metallurgy ages in ancient Egypt ( the old kingdom). The examination and analysis were carried out by USB microscope, polarized light microscope, scanning electron microscope equipped energy dispersive X-ray and X-ray diffraction. The results revealed that the basin was made of pure copper metal and manufactured as one piece by a hammering method. Metallographic examination showed a recrystallized microstructure, composed by the mechanical process for manufacturing the basin throughout hammering and annealing. The cylindrical body (rim) was in well- preserved state although it was covered with a thin layer of usual green corrosion products. The pustules of warty corrosion were formed on the inner surface of the rim. The curly shape of malachite corrosion were also observed. The morphology and mechanism of warty corrosion were presented and the difference between this type and the pitting corrosion was discussed. The characterization of the basin contributed to understanding and evaluating the preservation condition, which contributes to choosing the appropriate conservation process.

The present paper aims at demonstrating possibilities of the comparative and historical method in linguistics in reconstructing ethno-cultural prehistory of ancient peoples. Methodologically, it is based upon the analysis of 46 Ancient Egyptian-Arabic lexical parallels most of which are unattested in other Semitic and Afrasian languages, collected by the Hungarian specialist in Egyptian and Aftrasian languages G. Takacs and his predecessors. The author was the first to notice that some of 46 lexical parallels for semantic or phonetic reasons can hardly be considered to be randomly surviving cognates; neither can they be descarded as lookalikes. He suggests that they are direct lexical borrowings. This suggestion implies undiscovered contacts between Egypt and proto-Arabic speakers. According to the author's glottochronological dating, proto-Arabic separated from Central Semitic in early 3rd mill. BCE. These contacts started as early as the Old Kingdom and lasted through Middle to New Kingdoms. He concludes that the striking feature in this discovery is not only presumed Egyptian loans in Arabic but a small minority of very likely Arabisms in Egyptian language of all these periods. He argues that the most “robust” cases may testify to the Urheimat of proto-Arabic speakers located within reach of Egypt. The author is also inclined to identify the people of Midianites mentioned in both Hebrew and Arabic sources as Proto-Arabic speakers. However, as his competence is limited to comparative Afrasian linguistics and Semitic etymology, he leaves this arguable question to discuss archaeologists and historians.

Underweight and overweight are serious health concerns for many children and could be associated with low physical-fitness levels. This study aimed (i) to evaluate the prevalence of underweight and overweight and (ii) to examine its association with the physical fitness levels in primary male and female schoolchildren. Including 13 government primary-schools, a cross-sectional survey was conducted between 2014 and 2017. Anthropometric characteristics together with the physical-fitness level were measured in 931 schoolchildren aged between 6- and 11-years old. The prevalence of under- and overweight children were 8.49% and 24.06%, respectively. These proportions were not significantly different between males and females and were affected by age (p < 0.001), with a higher prevalence of overweight and a lower prevalence of underweight at 9–11 years, compared to 6–8 years old. Concerning the physical fitness levels, statistical analysis showed a better performance among males compared to females, among participants aged 9–11 years, compared to 6–8 years old, and among underweight and normal-weight, compared to overweight children (p < 0.001). There was a higher prevalence of overweight and lower prevalence of underweight at 9–11 years compared to 6–8 years old. Physical fitness levels were better in (i) males, compared to females, (ii) schoolchildren aged 9–11 years, compared to 6–8 years old, and (iii) underweight and normal-weight, compared to overweight children.

The article is devoted to the significant phenomena in the evolution of material part of the ancient Egyptian burial rites and funerary cult of the Old Kingdom (3rd millennium BC) — using of model substitutes of objects in various rituals in the necropolises of the Memphis region. Analysis of historical sources shows that the Egyptians, at the dawn of their dynastic history, came to the need to reduce the material costs for the afterlife sphere with the increasing complexity of the burial rites and funerary cult. Their complication progressed in parallel with their transition from the category of real actions to the category of symbolical ones. The more things the deceased needed for a prosperous existence in the afterlife, the more often these things were replaced by their symbols, which were supposed to turn into real ones in the other world with the help of various magical rituals. In course of time, the complex burial rites and funerary cult of the Egyptian nobility simplified, but the rational idea that quantity can replace quality and contribute to well-being in the afterlife remained and was embodied, in particular, in the multiplication of various symbols of apotropaic amulets.

The ancient Egyptian rock-cut tomb of Nesemnau in the north-eastern part of the Giza Necropolis was explored by the Russian Archaeological Mission of the Institute of Oriental Studies RAS in 2015–2017 and 2020. Archaeological study of the three tomb shafts revealed repeated violation of the filling layers due to the numerous robberies; as a result, the original burials of the Old Kingdom were destroyed, and later pottery (827 out of 2602 ceramic samples) and artifacts entered these complexes. Pottery analysis dating from the New Kingdom to the beginning of the 20th century allows speculating on the formation of thieves’ debris in the burial shafts of this tomb. Obtained data indicates repeated human intervention into the tomb, occurring apparently in the Late Period (possibly in order to create secondary burials), in Ptolemaic and Byzantine times, in the Middle Ages and in Modern times (during the robbery). Fragments from the same vessels are present in the fillings of all the shafts in Nesemnau’s tomb; therefore, they ended in these burial complexes at the same time as a result of the one and the same group of robbers’ activities. The latest ceramic fragments belonging to the zir-jars of the 19th — early 20th centuries indicate terminus ante quem of plundering. It is probable that the increase of tourism and the beginning of large-scale archaeological excavations in Giza Necropolis at that time intensified the thieves’ activity at the ancient site.

Background Egypt is a country of nearly 100 million citizens, and there are less than 1000 registered psychiatrists. The mental health care system is under resourced and nearly inaccessible for the majority of the population. In addition, youth under the age of 25 years represent 50% of Egyptian citizens; however, there are no specific services addressing their unique needs. How can the needs of the largest population in the Middle East be effectively addressed? Is a web-based framework an option for Egyptian psychiatrists to serve the population? Objective The aims of this study were to better understand the opinions of psychiatrists on the current state of mental health care services in Egypt and their current knowledge on electronic mental health (EMH); assess the attitudes of Egyptian psychiatrists toward web-based interventions and telemedicine for mental health; and identify perceived advantages and barriers of EMH development in Egypt. Methods A cross-sectional survey was conducted online among 640 Egyptian psychiatrists. It included a total of 36 items within a set of 16 questions asking about EMH literacy, integrating EMH into the mental health care system, and the perceived priorities and barriers of EMH. The sampling was supported by Tanta University, a large academic institution close to Cairo. Statistical analysis was performed using SPSS 25 (IBM Corp). Descriptive statistics, the chi-square test, the independent sample t test, and analysis of variance were applied. Results A total of 188 participants responded (response rate of 29.4%), of which 54.2% (102/188) were female and 54.3% (102/188) were between 30 and 45 years old. Less than half of the participants thought that the current health care system was efficient for adults (69/155, 44.4%), and even less thought it was efficient for youth (44/155, 28.3%). Almost all participants agreed that EMH would be beneficial for patient care (147/155, 94.8%) and that integrating EMH into the current health care system would be a good idea (118/155, 76.2%). The highest rated utility of web-based solutions was documentation, followed by psychoeducation and communication with professionals. The main advantages were to improve access to care in rural areas of the country and its convenience. Conclusions There is scarcity of mental health resources in Egypt. Egyptian psychiatrists are interested in EMH and believe web-based platforms can become part of the solution for the Egyptian mental health care system.

Abstract Background : Identification of JAK-2 mutation even in absence of myeloproliferative disorders was found to be related to venous thromboembolism occurrence. The aim of this work is to screen myeloproliferative neoplasm ( MPN) patients for venous thrombosis and study its correlation with both JAK 2 allele burden and with symptoms the patients presented with. Methods: We enrolled 73 cases with JAK2 positive MPN in the period between August 2015 till Feb 2017. All patients were screened for thrombosis in venous system in neck, upper and lower limbs, superior and inferior Venae Cavae and portal and mesenteric venous systems system using color Doppler Ultrasound. Results: 53 patients (72.6%) were below 60 years. Forty even (64.4%) were females and 26(35%) were males. Twenty two (30%) of cases were Essential Thrombocytosis (ET), 35(248%) were Polycythemia Vera (PV) and 16 (22%) were Myelofibrosis (MF). Twenty seven venous thrombotic attacks were reported in twenty two patients (30.1%). Seventeen patients (23%) had mesenteric and portal vein thrombosis,six patients had iliofemoral (8%) and 4 (5%) had combined lower limb and portal thrombosis. Eight patients (10.8%) had active thrombosis at screening. Only three (4%) patient were symptomatising with pain during screening. Sixteen patients with thrombosis were below 60 (30% of those below 60 years) and 6 were above sixty years (also 30% of those above sixty years). Correlation analysis between JAK2 allele burden and thrombosis was not statistically significant (r=0.3 ,p value=0.5). However, JAK 2 allele burden was statistically higher in those above sixty years in both thrombosed and non-thrombosed cases in comparison to those below sixty years (p= 0.03, 0.017 respectively). The incidence of pruritis (p =0.02) and of abdominal pain (p=0.039) was significantly different between thrombosed and non-thrombosed cases. Comparison of 8 cases with active thrombosis to old thrombosis revealed no statistical difference in the MPN10 score (p>0.05). Conclusion: We recommend routine screen for venous thrombosis in any case of MPNs once diagnosed and screening for MPNs in any case with venous thrombosis . Further research in MPN group age below 60 years of age is highly recommended. Disclosures No relevant conflicts of interest to declare.

The prevalence of hypertension is becoming more common in children and adolescents than ever before. Thus, the aim of this study was to evaluate the associations between the built environment on physical activity, sedentary behaviour, waist circumference, and health amongst adolescents in Saudi Arabia. A systolic and diastolic blood pressure, resting heart rate and waist circumference of 380 boys and girls aged between 15–19 years old (male = 199 and females = 181) were measured. The International physical activity Questionnaire Short Form was used to assess the physical activity levels and time spent sitting. The statistical analysis conducted were means and standard deviation, 2-way and 3-way of variance (ANOVA), Bonferroni post hoc tests, Chi-squared distribution and Pearson’s correlations. Among males, 16.75% were classified as hypertensive, 12.69% as pre-hypertensive, and 70.56% as normal whereas, females, 23.20% were classified as hypertensive, 12.15% as pre-hypertensive and 64.64% as normal. There were significant differences (F1,379 = 16.50, p < 0.001) between males and females waist circumference. Pearson’s correlation also revealed significant positive relationships in sedentary time (r = 0.123, p < 0.016), WC (r = 0.104, p < 0.043), and systolic blood pressure (r = 0.110, p < 0.032). The results revealed that systolic and diastolic blood pressure are significantly related to multiple measures of weight status, and sedentary behaviour. The results also highlight that active youth had lower resting heart rate compared to inactive peers. The present findings provide a foundation of knowledge for future research and highlight the major need for research and policy interventions, to address the concerning health habits of Al-Ahsa youth and broader Kingdom of Saudi Arabia.

Fundamental to the understanding of human history is the ability to make interpretations based on artifacts and other remains which are used to gather information about an ancient population. Sequestered in the organic matrices of these remains can be information, for example, concerning incidence of disease, genetic defects and diet. Stable isotopic compositions, especially those made on isolates of collagen from bones, have been used to help suggest principal dietary components. A significant problem in the use of collagen is its long–term stability, and the possibility of isotopic alteration during early diagenesis, or through contaminating condensation reactions. In this study, we suggest that a commonly overlooked material, human hair, may represent an ideal material to be used in addressing human diets of ancient civilizations. Through the analysis of the amino–acid composition of modern hair, as well as samples that were subjected to radiation (thus simulating ageing of the hair) and hair from humans that is up to 5200 years old, we have observed little in the way of chemical change. The principal amino acids observed in all of these samples are essentially identical in relative abundances and content. Dominating the compositions are serine, glutamic acid, threonine, glycine and leucine, respectively accounting for approximately 15%, 17%, 10%, 8% and 8% of the total hydrolysable amino acids. Even minor components (for example, alanine, valine, isoleucine) show similar constancy between the samples of different ages. This constancy clearly indicates minimal alteration of the amino–acid composition of the hair. Further, it would indicate that hair is well preserved and is amenable to isotopic analysis as a tool for distinguishing sources of nutrition. Based on this observation, we have isotopically characterized modern individuals for whom the diet has been documented. Both stable nitrogen and carbon isotope compositions were assessed, and together provide an indication of trophic status, and principal type (C 3 or C 4 ) of vegetation consumed. True vegans have nitrogen isotope compositions of about 7‰ whereas humans consuming larger amounts of meat, eggs, or milk are more enriched in the heavy nitrogen isotope. We have also analysed large cross sections of modern humans from North America and Europe to provide an indication of the variability seen in a population (the supermarket diet). There is a wide diversity in both carbon and nitrogen isotope values based at least partially on the levels of seafood, corn–fed beef and grains in the diets. Following analysis of the ancient hair, we have observed similar trends in certain ancient populations. For example, the Coptics of Egypt (1000 BP) and Chinchorro of Chile (5000–800 BP) have diets of similar diversity to those observed in the modern group but were isotopically influenced by local nutritional sources. In other ancient hair (Egyptian Late Middle Kingdom mummies, ca . 4000 BP), we have observed a much more uniform isotopic signature, indicating a more constant diet. We have also recognized a primary vegetarian component in the diet of the Neolithic Ice Man of the Oetztaler Alps (5200 BP). In certain cases, it appears that sulphur isotopes may help to further constrain dietary interpretations, owing to the good preservation and sulphur content of hair. It appears that analysis of the often–overlooked hair in archaeological sites may represent a significant new approach for understanding ancient human communities.

Toilet training in children is an attempt to train children so that the children were able to control in the conduct of urination and defecation. Do urinate and defecate, children need good preparation physically, psychologically or intellectually, through the preparation of the expected child able to control bowel movements and urination with independently. Factors that can affect the success of toilet training is parenting the mother or parents. A survey in the United Kingdom, was a half million children aged 6-16 years still love bed wetting, about 17% of children aged five years, 14% of children aged seven years, 9% of children aged nine years old, and 1-2% of the children aged 15 years still bedwetting. As for the cases of bedwetting in children 6 years of age in Indonesia is around 12%. This study aims to determine the relationship between mother's parenting with successful toilet training in preschoolers (4-6 years) in Raudhatul Athfal Al-Mu'minin District Ciamis. This type of research is quantitative with cross sectional study design. Total population 82 people and sampling by way of purposive sampling. Bivariate analysis using Chi Square test. The results showed that as many as 63 respondents (100%) that implementing democratic parenting all succeed in toilet training, as much as 2 respondents (100%) that implements the authoritarian parenting all haven't managed to do the toilet training and as many as 3 of the respondents (100%) that implements the permissive parenting all have not succeeded in toilet training. The result of statistical test, p value = 0.000 <(? = 0,05) means that there is a significant correlation between mother care pattern with successful toilet training in preschool age children (4-6 years). Conclusion of this study is that there is a significant relationship between mother care pattern with successful toilet training in preschool children (4-6 years) in Raudhatul Athfal Al-Mu'minin District Ciamis. It is expected that mothers can apply democratic parenting so that successful toilet training can be achieved.

Background and AimConcentrated standardised parenteral nutrition (CSPN) may reduce the delay in commencing parenteral nutrition (PN) in preterm infants compared with conventional individualised PN. Optimisation of early nutrition, with emphasis on earlier commencement of PN to include amino acids and addition of lipids within 24 hours of birth, ameliorates early postnatal growth failure.1 2 Cumulative nutritional deficit often seen in significantly preterm infants may lead to poor neurodevelopmental outcome.3 4 CSPN was introduced in our neonatal unit in December 2017 with the objective of improving early nutrition. The aim of this service evaluation was to assess the suitability of CSPN and its impact on the growth of preterm infants in our tertiary level neonatal unit.MethodsIn December 2017, the neonatal PN provided was switched from individualised PN to CSPN based on a modified ‘SCAMP’ regimen. Retrospective and prospective growth parameter data was collected for infants receiving PN within 24 hours of birth born between September to November 2017 (individualised PN arm) and from September to November 2018 (CSPN arm). Infants were excluded if they died or transferred out of the local neonatal service before day 28 of life, or died before transitioning from PN to full enteral feeds. Weight and head circumference at birth, 28 days old and 36 weeks corrected gestation/discharge were converted to z scores using the LMS method. The Mann-Whitney test was used to compare continuous data. Annual PN expenditure, and wastage of ordered PN, before and after the switch to CSPN, was calculated using the pharmacy stock management system, pharmacist and finance records.Results20 infants (mean gestational age 28 weeks) and 21 infants (mean gestational age 29.6 weeks) were included in the CSPN and individualised PN groups respectively. There were no differences in demographic data of each group. CSPN was commenced earlier (median 8 hours old (n=20)) than individualised PN (median 25 hours old (n=19)), (U=42, p<0.0001). There was no statistical difference in the change in weight z score from birth at 28 days old (median -0.47 (n=20) CSPN vs -0.66 (n=19) individualised PN, U=178.5, p=0.75) and at 36 weeks corrected gestation/discharge (median -0.72 (n=20) CSPN vs -0.86 (n=21) individualised PN, U=106, p=0.7). There was insufficient data collected to analyse effect on head circumference. Replacing individualised PN with CSPN resulted in a 37% reduction in procurement costs, despite an increase in the wastage of ordered PN from 7.2% to 8.5%.ConclusionA PN strategy using concentrated standardised PN can be implemented successfully in a tertiary neonatal unit setting in the United Kingdom and allows earlier commencement of PN. Use of CSPN appeared to have no adverse effect on weight gain, although small sample size may account for the lack of statistical significance in improvement of weight z score seen. Improved rates of head circumference documentation for our patients are required. Introducing CSPN resulted in a considerable reduction in procurement costs, and identifying strategies to minimise wastage of CSPN bags would further improve cost-effectiveness.ReferencesMorgan C, McGowan P, Herwitker S, et al. Postnatal head growth in preterm infants: a randomised controlled parenteral nutrition study. Pediatrics 2014;133:e120–8.Moyses HE, Johnson MJ, Leaf AA, et al. Early parenteral nutrition and growth outcomes in preterm infants: a systematic review and meta-analysis. Am J Clin Nutr 2013;97:816–26.Ehrenkranz RA, Dusick AM, Vohr BR, et al. Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics 2006;117:1253–61.Dusick AM, Poindexter BB, Ehrenkranz RA, et al. Growth failure in the preterm infant: can we catch up?Semin Perinatol 2003;27:302–10.

Background During the Coronavirus Disease 2019 (COVID-19) pandemic, the United Kingdom government imposed public health policies in England to reduce social contacts in hopes of curbing virus transmission. We conducted a repeated cross-sectional study to measure contact patterns weekly from March 2020 to March 2021 to estimate the impact of these policies, covering 3 national lockdowns interspersed by periods of less restrictive policies. Methods and findings The repeated cross-sectional survey data were collected using online surveys of representative samples of the UK population by age and gender. Survey participants were recruited by the online market research company Ipsos MORI through internet-based banner and social media ads and email campaigns. The participant data used for this analysis are restricted to those who reported living in England. We calculated the mean daily contacts reported using a (clustered) bootstrap and fitted a censored negative binomial model to estimate age-stratified contact matrices and estimate proportional changes to the basic reproduction number under controlled conditions using the change in contacts as a scaling factor. To put the findings in perspective, we discuss contact rates recorded throughout the year in terms of previously recorded rates from the POLYMOD study social contact study. The survey recorded 101,350 observations from 19,914 participants who reported 466,710 contacts over 53 weeks. We observed changes in social contact patterns in England over time and by participants’ age, personal risk factors, and perception of risk. The mean reported contacts for adults 18 to 59 years old ranged between 2.39 (95% confidence interval [CI] 2.20 to 2.60) contacts and 4.93 (95% CI 4.65 to 5.19) contacts during the study period. The mean contacts for school-age children (5 to 17 years old) ranged from 3.07 (95% CI 2.89 to 3.27) to 15.11 (95% CI 13.87 to 16.41). This demonstrates a sustained decrease in social contacts compared to a mean of 11.08 (95% CI 10.54 to 11.57) contacts per participant in all age groups combined as measured by the POLYMOD social contact study in 2005 to 2006. Contacts measured during periods of lockdowns were lower than in periods of eased social restrictions. The use of face coverings outside the home has remained high since the government mandated use in some settings in July 2020. The main limitations of this analysis are the potential for selection bias, as participants are recruited through internet-based campaigns, and recall bias, in which participants may under- or overreport the number of contacts they have made. Conclusions In this study, we observed that recorded contacts reduced dramatically compared to prepandemic levels (as measured in the POLYMOD study), with changes in reported contacts correlated with government interventions throughout the pandemic. Despite easing of restrictions in the summer of 2020, the mean number of reported contacts only returned to about half of that observed prepandemic at its highest recorded level. The CoMix survey provides a unique repeated cross-sectional data set for a full year in England, from the first day of the first lockdown, for use in statistical analyses and mathematical modelling of COVID-19 and other diseases.

BACKGROUND: No gold standard therapy was approved globally for COVID-19 pneumonia to the date of this study. The pathophysiology of SARS-CoV-2 infection displayed the predominance of hyperinflammation and immune dysregulation in inducing multiorgan damage. Therefore, the potential benefits of both immune modulation and suppression in COVID-19 have been extensively discussed as a modality to control cytokine release syndrome (CRS). Abnormally high levels of interleukin-6 (IL-6) are a common finding in COVID-19 patients with pneumonia and acute respiratory distress syndrome, so the use of IL-6 antagonist was tested as a therapeutic option in controlling the disease. Tocilizumab is a recombinant humanized anti-human IL-6 receptor monoclonal antibody that can specifically bind the membrane-bound IL-6 receptor and soluble IL-6 receptor, thereby inhibiting signal transduction. Tocilizumab is currently FDA approved for the management of rheumatoid arthritis, giant cell arthritis, polyarticular juvenile idiopathic arthritis, and systemic juvenile idiopathic arthritis. This study is a retrospective analysis of data polled during Phase I of COVID pandemic, adopted by the isolation hospital of Kasr Al-Ainy Medical School, Cairo University, during the period from May to September 2020. AIM: The aim of this study is to evaluate tocilizumab influence in the outcome; in terms of reducing the hospital stay, risk and duration of mechanical ventilation (invasive and noninvasive), mortality, and the incidence of complications related to drugs use (secondary bacterial infection and GIT bleeding) in patients with moderate-to-severe COVID-19. METHODS: This retrospective, observational cohort study included adults (between 18 and 80 years) with moderate-to-severe COVID-19 pneumonia, who were admitted to isolation hospital of Kasr Al-Ainy Medical School, Cairo University, between May and September 2020. We segregated the patients into two groups: Group A: In addition to the standard care protocol according to the local guidelines of the Egyptian Ministry of Health and Population in that period (supplemental oxygen, steroids in a dose of 1–2 mg/kg methylprednisolone for 5–10 days, broad-spectrum antibiotics, vitamins, and prophylactic dose of anticoagulation with low-molecular-weight heparin, proton-pump inhibitor, and poly-vitamins), they received tocilizumab intravenously in a dose of 8 mg/kg bodyweight (up to a maximum of 800 mg per dose), divided in two shots 12–24 h apart. Group B: Those received the standard care protocol alone, noting that guidelines were adjusted later on according to the updated scientific publications and WHO recommendations. The primary endpoint was to evaluate the effect of different regimens in controlling the disease, the need for mechanical ventilation and its duration (either invasive or non-invasive), length of ICU stay, hospital stay, and in-hospital mortality. Comparisons between quantitative variables were done using the non-parametric Mann–Whitney U-test. For comparison of serial measurements within each patient, the non-parametric Wilcoxon signed-rank test was used. For comparing categorical data, Chi-square (2) test was performed. Exact test was used instead when the expected frequency was <5. Correlations between quantitative variables were done using Spearman correlation coefficient. RESULTS: During this period, 166 patients were admitted to ICU, suffering from severe hypoxemia with moderate to severe COVID-19 pneumonia, 10 of them were excluded (three were over 80 years old, other three had advanced stages of malignancy, two were on steroids therapy and non-invasive home ventilation due to chronic chest condition, and two were presented with MODs and deceased in <48 h from admission), thus, 156 were included in the study. Group A: Seventy-six patients (49%) received tocilizumab in addition to standard therapy, Group B: Eighty patients (51%) received standard therapy only. In Group A, the mean length of ICU stay was 8.96 days with mean length of hospital stay 13.76, compared to mean length of ICU stay 9 days in Group B (p = 0.57) and mean length of hospital stay 12.46 days (p = 0.117). In Group A, 35 patients (46%) needed non-invasive mechanical ventilation (MV),12 patients of the 35 needed invasive MV in later stage, compared to 26 patients (32%) in Group B, 14 patients of the 26 needed invasive MV in later stage (p = 0.16). In Group A, 14 patients (18.4%) needed invasive mechanical ventilation, compared to 19 patients (23.7%) in Group B (p = 0.213). In Group A, 6 (7.9%) of 76 patients died, compared to 13 (16.3%) of 80 in Group B p = 0.11. The incidence of secondary bacterial infection in Group A was 16 patients (21%) compared to 21 (26%) in Group B (p = 0.44). CONCLUSION: In this study, we did not detect statistical difference in both groups of patients coming during CRS-associated COVID-19 pneumonia, regarding (ICU stay, need for and length of MV, the incidence of secondary bacterial infection, and in-hospital mortality) for COVID-19 moderate-to-severe pneumonia.

Abstract Background Nowadays, the best evidence for symptomatic patients with Multiple Myeloma (MM) is initial induction therapy with more than two drugs that contains bortezomib. If patients are eligible it is established the use of high dose chemotherapy and autologous stem cell transplantation (ASCT). We do not have to prescribe in Brazilian public health service, due to economic reasons, new drugs such as: bortezomib and lenalidomide. On the other hand, it is known that Cyclophosphamide, thalidomide and dexamethasone (CTD) regimen is an effective primary therapy for MM and it is widely used in some countries such as United Kingdom. We have been prescribing for first line therapy CTD regimen in our clinical practice for approximately 4 years. Thus, we performed a retrospective analysis of patients with MM treated with CTD regimen in the Instituto do Câncer do Estado de São Paulo. Here we present response rate, reduction dose rate, toxicity rate and progression free survival (PFS) and overall survival (OS). Patients and Method We studied 71 patients that were submitted as first line treatment CTD, during 2006-2012. This regimen consists: Cyclophosphamide 500mg orally on days 1, 8, 15; Thalidomide 100mg orally on days 1 to 28 and Dexamethasone 40mg orally on days 1 to 5 and 14 to 18, every 30 days. To sensitive and eligible patients, we have submitted them for ASCT. PFS and OS were calculated by the Kaplan-Meier method. PFS was calculated from the start of treatment until progression or death or last follow-up and OS until death or last follow-up. GraphPad Prism (v5.0) software was used for statistical calculations, and P values < 0.05 were considered to be statistically significant. Results In the 71 patients, 54.2% were male patients, the median age was 57.81 years old (± 7.96). Out of the 71 patients (78.7%), were classified by Durie Salmon staging as IIIA or IIIB and 30% presented stage III for the International Staging System (ISS). Fifty seven (80.2%) were considered eligible for ASCT in the beginning of treatment. Moreover, the evidences of end-organ damage felt related to the plasma cell disorder were: lytic lesions 78.6%; anemia 51.4%, renal failure 20% and hypercalcemia 11.4%. The median of CTD cycles prescribed was 6.44 (± 2.62) and 47.1% were treated in the beginning without adjustment doses. It was evidenced 5.63% deaths related to the treatment. It was observed adjustment doses after 1st cycle in 35.7% of patients due to: peripheral neuropathy 36%, tremor 16%, thrombosis 12%, bradycardia 12% and others 24%. It was observed in 71 patients: 6 (8.45%) stable disease (SD); 4 (5.63%) progressive disease (PD); 26 (36.66%) partial response (PR); 15 (21.1%) very good partial response (VGPR) and 16 (22.53%) complete response (CR), it was not possible to analyze 4 (5.63%) patients due to death. Of total eligible patients to ASCT, 57.62% were submitted for ASCT and in this moment 6.7% have been preparing for ASCT. The median of PFS was 29.2 months (CI 95% 0,22-0,66) and median of OS was not achieved. It was observed difference in OS between patients with stage III for the ISS: 28,92 months versus (vs) patients with stage I and II median not reached, p = 0.0105. PFS study demonstrated curves that patients responding to CTD at least VGPR (VGPR+CR) presented better median PFS 37.48 months than others patients (PR+PD+SD) 17.93 months, p=0.0018. Only patients that presented PD and SD response to CTD had a significantly shorter OS median 19.21 months than patients responses at least PR (PR+VGPR+RC) median was not reached, p < 0.0001. Conclusion We conclude that CTD is a feasible regimen where is not possible to prescribe new drugs, with acceptable toxicity. Moreover, patients that presented at least VGPR and at least PR to CTD demonstrated better PFS and OS, respectively. Disclosures: No relevant conflicts of interest to declare.

Background: Although typically an aggressive disease some patients with Mantle Cell Lymphoma (MCL) follow an indolent course and may not benefit from immediate therapy. Several studies evaluating watch-and-wait (W&W) strategies in MCL show no detriment to patient survival and international guidelines acknowledge the strategy's suitability for a minority of patients. Differences in pathogenetic mechanisms have provided insight into variable clinical behaviour, but there is little clinical evidence to inform patient suitability for W&W. The MCL Biobank Observational Study is a prospective study designed to distinguish indolent from aggressive forms of MCL. Tissue samples and baseline characteristics are collected at enrolment. The study has recruited over 550 patients across the UK and remains open to recruitment. Method: This analysis includes 315 patients from 58 centers in the United Kingdom enrolled between January 2015 and March 2018. All new MCL diagnoses compatible with WHO diagnostic criteria were eligible. Patients were enrolled within 90 days of diagnosis and prior to receiving therapy. Baseline data was recorded including investigator decision to start systemic therapy or enter W&W. Clinical updates were provided at 6 month intervals and patients were followed-up for a minimum of 12 months. Standard statistical methods were used to examine which factors were associated with initial disease management and those remaining on W&W long-term. Time to treatment was measured from date of diagnosis until date of first treatment, patients who had not commenced treatment were censored at the last date of follow-up. Results: Median age of all patients was 71 (range 32-92), 68.9% were male, 53.5% were MIPI high risk and median follow up 26 months. At baseline 67.3% of patients received upfront systemic therapy, 4.1% received localized radiotherapy, 1.0% were palliated and 27.6% were on W&W 90 days beyond diagnosis. Estimated 2-year OS of the whole population was 77.5%. Patients on initial W&W tended to be older than those treated early (median 73 yrs vs. 71 yrs), had similar performance score (ECOG>1 OR 1.16, p=0.68) and no significant difference in WBC (WBC>15 OR 0.55, p=0.07). Although high risk MIPI was equally prevalent between the groups (OR 1.3, p=0.31) it was notable that no patient under 75 years was high risk in the observation group. Presence of measurable disease on CT discriminated between the two groups (OR 0.23, p=<0.001), but 71% of W&W had measurable disease indicating most were not the leukemic subtype. Markers of higher cell turnover, raised LDH and Ki67≥30%, were significantly less common in W&W patients (OR 0.32, p=<0.001; OR 0.3, p=0.001). 40% of women were put on W&W compared to 22% of men (OR 2.6, p=<0.001). Of 87 patients followed on W&W 73.5% remained on observation at 1 year and 50.6% at 2 years, with median follow up 2.4 years. Univariate analysis revealed few baseline characteristics to be predictive for prolonged period of observation, in part relating to the low patient numbers, but key observations are displayed in figure 1. Patients with Ki67≥30% were less likely to remain on observation (HR 2.39, p=0.03), as were patients over 80 years old (HR 3.67, p=0.007), and those MIPI high risk compared to low risk (3.56, p=0.02). Conclusion: This study demonstrates the high prevalence of W&W in UK clinical practice and it provides reassurance to clinicians that half remain on observation beyond 2 yrs. LDH level and Ki67 status reflect the biological nature of disease and it is therefore not unexpected that lower levels predict for a more indolent course. However, with Ki67≥30 in 25% of patients observed beyond 2 years these measures alone are not sufficient to decide treatment. The tendency for older patients to be observed likely reflects a less aggressive clinical approach in patients with co-morbidities, and not the underlying biology. This explains the tendency for shortened observation period in older patients. The high prevalence of female patients in W&W is a striking observation that alludes to pathophysiological differences between the sexes that warrants further investigation. Although the study highlights clinicians are increasingly at ease adopting W&W in MCL, it also demonstrates the need for better predictive markers of indolent disease. This study aims to achieve this with analysis of the collected tissue samples. Disclosures Crosbie: Janssen: Honoraria. Rule:Sunesis: Consultancy, Honoraria; TG Therapeutics: Consultancy, Honoraria; Napp: Consultancy; Kite: Consultancy; Gilead: Consultancy, Honoraria; Pharmacyclics: Consultancy, Honoraria; Celgene: Consultancy, Honoraria; Astra-Zeneca: Consultancy, Honoraria; Roche: Consultancy, Honoraria, Research Funding; Janssen: Consultancy, Honoraria, Research Funding.

Discussions of the early Egyptian state suffer from a weak consideration of scale. Egyptian archaeologists derive their arguments primarily from evidence of court cemeteries, elite tombs, and monuments of royal display. The material informs the analysis of kingship, early writing, and administration but it remains obscure how the core of the early Pharaonic state was embedded in the territory it claimed to administer. This paper suggests that the relationship between centre and hinterland is key for scaling the Egyptian state of the Old Kingdom (ca. 2,700-2,200 BC). Initially, central administration imagines Egypt using models at variance with provincial practice. The end of the Old Kingdom demarcates not the collapse, but the beginning of a large-scale state characterized by the coalescence of central and local models.

Abstract Background The choice between extraction and expansion treatment is an endless debate in orthodontics. Ethnic and secular variations showed that there was a change in arch perimeter over the last 50 years. Accordingly, the purpose of this study was to investigate the relation between the arch perimeter and the intercanine and intermolar widths in normal occlusion. Also, to design regression equations for the prediction of the arch perimeter based on arch width, in a sample of the Egyptian population. The images of 340 cast pairs for 11 to 13-year-old patients were traced using TracerNet. Intercanine width, intermolar width and arch perimeter were measured, statistical analysis was performed and regression equations for both arches were formulated. Results There was a positive correlation between the lower arch AP, ICW and IMW and between the upper arch AP and ICW. Lower arch perimeter = 0.536 I33 + 71.642, lower arch perimeter = 0.828 l66 + 58.604 and upper arch perimeter = 1.988 U33 + 30.492 were the significant derived equations. Conclusions The formulation of regression equations offers a tool for the prediction of arch perimeter or arch width that can act as a guide in diagnosis and treatment planning.

Abstract Background Transition to college is characterized by change, ambiguity, and adjustment compared to the previous lifestyle before entering college. Our study aimed was to determine the pattern of students’ physical exercise practices in the Kingdom of Saudi Arabia in the period before and during college attendance. Methods A cross-sectional study was conducted among university students from fifteen universities in the Kingdom of Saudi Arabia on August 2017. The data were collected using an electronic questionnaire that was modified from questionnaires used in previous studies. Statistical analysis and data entry was performed with SPSS version 21. This study was approved by the Research Ethics Committee at King Abdulaziz University. Results 417 college students completed the questionnaire and 77.2% were female. Slightly more than half of the participants (55.9%) were from King Abdulaziz University, and 59.7% were from healthcare specialties from different institutions. The mean age of the participants was 21.80 years old (SD = 2.75). The pattern of practicing physical exercise showed a significant decrease after enrollment in college (p = 0.000). The most common reason for not practicing exercise was time restrictions, accounting for 18.5% of all the reasons, while the most common reason for practicing exercise was to improve body shape, accounting for 48% of all the reasons. Conclusions Our research found that there was a significant decrease in doing regular exercise during one’s college years in comparison to the school years prior to college. To address the decrease in physical exercise, we recommend organizing and promoting more awareness campaigns and providing suitable sports facilities and infrastructure.

Abstract Research question To assess the relationship between the number of oocytes retrieved during elective oocyte cryopreservation (EOC) cycles with various clinical, biochemical, and radiological markers, including age, body mass index (BMI), baseline anti-Müllerian hormone (AMH), antral follicle count (AFC), Oestradiol level (E2) and total number of follicles ≥ 12 mm on the day of trigger. To also report the reproductive outcomes from women who underwent EOC. Methods A retrospective cohort of 373 women embarking on EOC and autologous oocyte thaw cycles between 2008 and 2018 from a single London clinic in the United Kingdom. Results 483 stimulation cycles were undertaken amongst 373 women. The median (range) age at cryopreservation was 38 (26–47) years old. The median numbers of oocytes retrieved per cycle was 8 (0–37) and the median total oocytes cryopreserved per woman was 8 (0–45). BMI, E2 level and number of follicles ≥ 12 mm at trigger were all significant predictors of oocyte yield. Multivariate analysis confirmed there was no significant relationship between AFC or AMH, whilst on univariate analysis statistical significance was proven. Thirty six women returned to use their cryopreserved oocytes, of which there were 41 autologous oocyte thaw cycles undertaken. There were 12 successful livebirths achieved by 11 women. The overall livebirth rate was 26.8% per cycle. No livebirths were achieved in women who underwent EOC ≥ 40 years old, and 82% of all livebirths were achieved in women who had done so between 36 and 39 years old. Conclusion Clinical, biochemical and radiological markers can predict oocyte yield in EOC cycles. Reproductive outcomes are more favourable when cryopreservation is performed before the age of 36, with lower success rates of livebirth observed in women aged 40 years and above.

Abstract Background The mortality rates of coronavirus disease 2019 (COVID-19) have been changed across the epidemiological waves. The aim was to investigate the differences in mortality rates of COVID-19 patients in Japan across the six epidemiological waves stratified by age group and 4C mortality score risk group. Methods A total of 56,986 COVID-19 patients in the COVID-19 Registry Japan from 2020/03/02 to 2022/02/01 were enrolled. These patients were categorized into 4 risk groups based on their 4C mortality score. Mortality rates of each risk group were calculated separately for different age groups: 18-64, 65-74, 75-89, and ≥90 years. In addition, mortality rates across the wave periods were calculated separately in 2 age groups: &lt; 75 and ≥75 years. All calculated mortality rates were compared with reported data from the United Kingdom (UK) during the early epidemic. Results The mortality rates of patients in Japan were significantly lower than in the UK across the board, with the exception of patients ≥90 years at very high risk. The mortality rates of patients ≥75 years at very high risk in the 4th and 5th wave periods showed no significant differences from those in the UK, whereas those in the 6th wave period were significantly lower in all age groups and at all risk groups. Conclusions The present analysis showed that COVID-19 patients had a lower mortality rate in the most recent 6th wave period, even among patients ≥75 years old at very high risk.

The aim of the research was to investigate the effectiveness of a computer based on photoshop in design and decoration and its impact on emotional intelligence among children in the age group (11-17 years). To achieve the research objectives, the researchers chose the quasi-experimental design with equal groups, the control group and the experimental group. The sample size was (44) students, (14) males and (30) females, who were chosen by random stratification method from the middle and high school levels in Jazan region in the age group (11-17). They were distributed into two equal groups (22) students for each of the control and experimental group. The researchers used the Bar-On scale for emotional intelligence in addition to the training program. The Statistical Package for Social Sciences (SPSS) program was used for analyzing data. The two-tailed T-Test was chosen to detect the differences between the binary groups and the univariate analysis. Variation: to detect differences between the interaction groups and the post-LSD test to determine the direction of the differences between groups of variable interaction (group x application). The research reached the following results: there are statistically significant differences in the average scores of children of age (11-17 years) on the emotional intelligence scale pre and post the application of the program, and there are statistically significant differences in the average performance of the experimental group on the emotional intelligence scale due to gender, and there are significant differences statistical differences in the average performance of the experimental group on the emotional intelligence scale due to age, and there are statistically significant differences in the average scores of 11-17 year old children on the emotional intelligence scale between the groups of variables of program application and type of education.

Background: Alopecia areata (AA) is an autoimmune disease that causes non-scarring hair loss. Significant epidemiological differences among the population observed throughout the investigation in the literature. The Kingdom of Saudi Arabia (KSA ) was found to have a greater burden of disease than other countries, but the information is lacking in Al Baha region, the southwestern area of KSA . Aim: The aim of the present study was to determine the clinico-epidemiological profile and burden of AA in the Al Baha region and to subsequently highlight the factors affecting disease prevalence. Methodology: A well-structured quantitative questionnaire was developed and distributed using an online standardized questionnaire targeting 385 Albaha patients diagnosed with AA. The diagnosis of AA was confirmed clinically by consultant dermatology before patient recruitment into the study and resulted in sufficient accuracy. The responses were collected and analyzed using SPSS statistical analysis software. The frequency of disease prevalence, patients’ ages, disease duration, impact on quality of life, risk factors, and associated diseases were analyzed. Results: A total of 385 AA patients completed the questionnaire to achieve 100% response accuracy. Most of them were located in Al-Baha center (36.1%) followed by Baljurashi city (17.1%). The most frequent age of AA diagnosis was 21–30 years old (41.3%), and the disease duration was 3–6 months in the majority of the patients (26.8%). The most common type is patchy scalp AA in 57.1% of the patients followed by AA involving more than one site (24.4%). Diabetes mellitus and chronic anemia were the associated diseases 10.9% (for both) followed by thyroid diseases in 5.2% of the patients. Conclusion: Overall, AA as a disease presents a significant concern for the population of Al-Baha region in Saudi Arabia considering the variable prevalence in different cities, especially in Al-Baha center itself. Onset occurs during adult working ages. Therefore, quality of life can be negatively affected, and outcomes can be severe. This study potentially adds more knowledge and theoretical understanding of AA clinico-epidemiology in our region. Keywords: hair loss, Al-Baha, Saudi Arabia, Epidemiology

AbstractObjectivesThis study aimed to assess the sleep quality (habits and disorders) and the daytime sleepiness among medical students.MethodsA cross-sectional questionnaire-based study was conducted during September 2018, through November 2018 at the Faculty of Medicine, Tanta University, Egypt. The study recruited undergraduate Egyptian and Malaysian students and applied a modified form of two questionnaires, namely the Sleep Habits and Life Style and the Epworth Sleepiness Scale (ESS)”. Statistical analysis was done using SPSS. The results were expressed as frequency, percentage, and mean ± standard deviation (SD). Chi-square test was used to explore associations between categorical variables. An independent sample t-test was used to detect the mean differences between groups. Ordinal regression analyses were done on the ESS findings in relation to demographics and sleep habits. p-values<0.05 were accepted as statistically significant.ResultsThe study included 899 medical students. Most of the participants were Egyptians (67%), rural residents (57.4%), and in the preclinical stage (79.5%). Males represented 66.0% of the study participants and participants average age (SD) was 21.98 (1.13) years. The average durations (SD) of night sleep were 7.3 (1.6) hours in work days and 8.7 (2.1) hours during the weekends. Both were significantly longer among young (<21 years-old) and preclinical students (p<0.05). Students had on average (SD) 1.33 (0.29) hours duration of napping, but 60% of the participants never or rarely scheduled for napping. Larger proportion of male and Malaysian students sometimes scheduled for napping more significantly than their peers (p<0.05). Only 16.24% of students reported that the cause of daytime napping was no enough sleep at night. The students reported sleep disorders of insomnia in the form of waking up too early, trouble falling asleep, or waking up at night with failure to re-sleep (31, 30, and 26%, respectively). Snoring (22.2%) and restless legs (22.0%) were also reported by the students. High chances of dozing off was reported by 22.02% of the participants, of which 10% used sleeping pills, 41.4% suffered psychological affection, and 34.8% reported life pattern affection. We found an increased chance of daytime sleepiness among males (0.430 times) and Egyptian (2.018 times) students. There was a decreased chance of daytime sleepiness in students from rural areas and those below 21-years-old (0.262 and 0.343 times, respectively). Absence of chronic diseases suffering was significantly associated with 5.573 more chance of daytime sleepiness or dozing off. In addition, enough and average sleep at night significantly decreased the chance of daytime sleepiness by 6.292 and 6.578, respectively, whereas daytime consumption of caffeinated beverages significantly decreased the chance of daytime sleepiness by 0.341.ConclusionThere was unbalanced sleep duration in work days and weekends as well as lack of scheduling for napping among the students. Sleep disorders as insomnia, snoring, and restless legs were associated with excessive daytime sleepiness. Some students who suffered daytime sleepiness also underwent psychological and life pattern affection including taking sleeping pills. Enough and average sleep duration at night as well as daytime consumption of caffeinated beverages decreased the chance of daytime sleepiness.

ABSTRACT We carried out multilocus sequence typing (MLST) on 148 pneumococcal carriage isolates collected from children <24 months old in the Upper River Division, the Gambia. MLST revealed a diverse population. Seventy-six different sequence types (STs) were found, the most common of which were 802 and 919, associated with 23F and 6A serotypes, respectively. Comparison with the MLST database showed that only 11 of the STs found in the present sample had been reported outside Africa. Six STs showed evidence of capsular switching (172, 802, 847, 1730, 1736, and 1737). Serotype switches were confirmed by microarrays that detected capsule genes. Of isolates analyzed by using microarrays, 40/69 (58%) harbored the tetM resistance determinant. A statistical genetic analysis to detect recombination found that 49/144 (34%) isolates showed significant (P < 0.05) evidence of admixture, which is greater than that observed in similar samples from the United Kingdom (5%) and Finland (2%). We hypothesize that large amounts of admixture could reflect the high prevalence of multiple carriage in this region, leading to more opportunities for homologous recombination between strains. This could have consequences for the population response to conjugate vaccination. IMPORTANCE The population structure of the pneumococcus in sub-Saharan Africa has barely been studied despite the high levels of morbidity and mortality due to pneumococcal disease in this region. We report the largest sample to date from carriage in sub-Saharan Africa to be typed by sequencing (multilocus sequence typing [MLST]) and microarray analysis. The results clearly show that the population is highly distinct and divergent from others studied in the United States and Europe. Moreover, in contrast with samples from developed countries, the population contains a high proportion of isolates showing a history of homologous recombination, which shuffles genetic information into new combinations and can generate drug-resistant and vaccine escape strains. This is likely to have important consequences for the evolutionary response of the pneumococcal population to conjugate vaccination targeting a subset of pneumococcal serotypes, which is under way in the Gambia and other countries.

Abstract Background and Aims Microalbuminuria is one of the early presentations of diabetic kidney disease that may progress to macroalbuminuria, progressive loss of glomerular filtration rate and eventually end stage renal disease. Early recognition and management of microalbuminuria can avert irreversible complications. Antihypertensive medications and antihyperlipidemic medications are medications that have been used to control diabetic nephropathy, but the reports of some side effects limited the usage of some of these drugs in diabetic patients. Pentoxifylline is an anti-inflammatory medication that have been experienced for clinical trials in diabetic patients with diabetic kidney disease. Effect of Pentoxifylline on albuminuria has been evaluated in several studies with different outcomes where a significant decrease in albuminuria in the Pentoxifylline group compared with placebo was the final conclusion. The aim of our study is the assessment of the value of Pentoxifylline addition in diabetic patients. Method Of 90 patients aged between 20 and 55 years old with a history of diabetes mellites type II for more than 5 years with normal serum creatinine and had a spot urinary albumin/creatinine ratio of &gt; 300 mg/g on two consecutive measurements with HBA1C &lt; 7% and lacking any history of glomerular disease, immunological, malignant nor cardiovascular disease in the previous 6 months nor using pentoxifylline for the past 3 month attending Ain Shams University clinics in Egypt from October 2017 to September 2018, 61 patients were eligible and randomly assigned in prospective, randomized, parallel-group, non-blind study after obtaining written informed consent from studied patients into 2 groups either the Pentoxifylline group (n = 30) receiving 400 mg thrice daily for 6 months or Ramipril group (n = 31) receiving 2.5 mg once daily on the same schedule. Blood samples and single first morning void urine samples were collected before breakfast after an 8–12 hours overnight fast. Plasma glucose, HbA1c, serum Creatinine, AST, ALT, and urinary protein / Creatinine levels were measured. All biochemical analyses were performed. Participants were followed up after 1, 3 and 6 months during the treatment period to evaluate the outcome Results Highly Statistically significant differences were noted as regard the reduction of the proteinuria levels at the same measurement points in both groups where the mean ranges of proteinuria in group 1 were found to be 2.2±1, 1.8±0.7, 1.4±0.6 mg\g at the start of the study, 3 and 6 month later respectively while in group 2 the mean range was found to be 2.6±1.2, 2±0.8, 1.6±0.7 mg\g with marked reduction of 20.6% after 3 month and 37.6% after 6 month from the start of the trial in group 1 in contrast to 20.7% and 40.2% respectively in group 2, also the effect of both drugs on the level of HbA1c has been studied in both group, in group 1 there was no reduction in the level of HbA1c after 6 month of drug administration in contrary to group 2 which showed a reduction of 4% where these results were found to be statistically significant in group 2 only. we also found statistically significant differences in both groups as regard the decline in eGFR throughout the trial duration which was 4% in group 1 and 6% in group 2. Conclusion We concluded that Pentoxifylline has a promising role as an antiproteinuric agent in comparison with ACEI from our statistical analysis of the study data with a more decline in eGFR throughout the trial duration in the study population using ACEI in comparison to Pentoxifylline. Due to restrictions of the study design these observations need further confirmation by prospective studies. Figure (1) showing comparison between both groups as regard the level of proteinuria and its reduction rate over 6 months Figure (2) showing eGFR levels at 0, 6 months in both groups Figure (3) showing comparison between both groups as regard HbA1C at baseline and after 6 months.

The Kingdom of Saudi Arabia is one of the largest Arab countries with a moderate annual problem of tuberculosis that is either pulmonary or extra-pulmonary. TB is still one of the most significant health troubles in the KSA, affecting different nationalities (Saudis, non-Saudis), ages, provinces, and genders. The control of TB still faces some challenges in different provinces of the KSA. Data were collected, arranged, analyzed and presented in tables and figures. In this retrospective study, we appraised TB surveillance data for the period between 2013 (1434H) and 2018 (1439H). Data were handled using Microsoft Excel and SPSS version 23. Data were checked for normality using Shapiro-Wilk normality test at 0.05 levels to determine whether they are parametric or nonparametric. Chi-squared, Kruskal Wallis, and analysis of variance tests were used to evaluate trends at a significance level of p< 0.05. Statistical analyses were performed using IBM-SPSS version 23 for Mac OS. We appraised TB surveillance data for the period between 2013 (1434H) and 2018 (1439H). The data included the region of the country (province), age, sex, and nationality (Saudis, non-Saudis). The study evaluated the impact of TB on various nationalities (Saudis and non-Saudis), age groups (0-14, 15-34, 35-55, more than 55 years old), and genders (males and females). Non-Saudis had a higher incidence rate than Saudis in 2013-2018. The number of cases and incidence rates of TB recorded in males between 2013 to 2018 were about two to three times greater than estimates for females. The Makkah, Riyadh, and Jeddah regions attract enormous numbers of non-Saudi migrant workers, who account for ~60% of all TB cases in the KSA. Assessing the main TB risk factors contributing to high TB rates in non-Saudi workers is essential. Furthermore, periodical accurate studies, including evidence-based studies for optimum surveillance, avoidance, spread risk, inspection, control procedures and treatment of TB, should be conducted. These assessments would lead to evaluating the strengths and weaknesses of KSA-NTP’s TB action plan.

In today's society there is evidence of a culture of the 'empowered consumer' -- an image of the consumer as a citizen rather than a subordinate. In fact, human rights language is increasingly coming to the fore in the consumption debate. The consumer has been allocated rights by the United Nations whereby all human beings are born free and equal and have civil, political, economic and social rights (McGregor 44). However, as citizens we also have responsibilities of an environmental and social concern. Food retailing and equality of shopping provision is one such concern. Food is a basic right. According to the Universal Declaration of Human Rights everyone has a fundamental right to be free from hunger and have access to safe and nutritious food. Social exclusion refers to those in the population who are unable to participate in economic, political, social and cultural life. Social exclusion is different from, but related to, poverty since it further marginalises the most disadvantaged -- for example, those who cannot access a large supermarket. In keeping with the rights/responsibilities language, the consumer has a basic right to food and the retailer has the social responsibility to supply the needs of the consumer. It is in this respect that food is an ethical issue and has social justice implications. Inability to consume, or have access to, sufficient food of nutritional quality is a global concern. In North America the issue is one of 'food insecurity' or 'food poverty' due to inadequate finance to purchase sufficient food. In the United Kingdom the same problem arises within the context of access to food stores. This is identified as a 'food (shopping) desert', where due to restricted access social exclusion can arise. The term 'food deserts' was first used by the Low Income Project Team of the Nutrition Task Force in 1996 and was succinctly defined by Tessa Jowell (Government Health Minister) in 1997 when she stated that a food desert was an area "where people do not have easy access to healthy, fresh foods particularly if they are poor and have limited mobility". The term 'food desert' is an emotive one referring to a unique tool of social polarisation and exclusion (Lang 5). The issues compounding the problem include low income, locational policy of supermarkets with the acquisition of edge-of-town / out-of-town sites, consumer mobility, car ownership levels and food availability. This research study focuses on Northern Ireland -- a region of the UK on the periphery of Europe. The Province of Northern Ireland (Ulster) is a sparsely populated (122 people per km²), predominantly rural area with the highest unemployment and poverty statistics in the United Kingdom. Similarly, Northern Ireland has a proportionately high degree of non-car ownership (35%) which further complicates the equation since shopping is increasingly becoming a car-borne activity necessitating transportation to edge-of-town superstores. Those not able to avail themselves of large edge-of-town superstores are being socially excluded, since inner-city areas are becoming denuded of food stores. Those that do exist usually have a limited range of food items, usually non-perishable, or are specialist shops stocking high priced items. It is the aim of the study to identify the characteristics, extent and location of food deserts in both rural and urban areas of Northern Ireland. It is a particularly apt time to do so since Northern Ireland is experiencing a 'retail revolution' with the arrival of the major UK grocery multiples and subsequent situational policies to locate off-centre. Similarly, there are plans to curtail out-of-town developments which has been viewed by some smaller retailers as "too little, too late". With the above in mind, it is a timely study for Northern Ireland. Multiple research tools of both a qualitative and a quantitative nature have been employed including consumer focus groups, shopping diaries, comparative shopping exercises, consumer questionnaires and retail interviews. This will enable sufficient validation of results. The focus groups provide qualitative depth (Colquhoun 39) and serve to highlight the issues of shopping inequality from the point of view of different consumer groups which could be identified as potentially vulnerable in the food poverty stakes; the elderly, the disabled, the unemployed or low income families, lone-parent families and females in general; to whom falls the responsibility for provisioning the household, organising the kitchen and doing the household's cooking (Murcott 11). Basically, food is gendered -- women are mainly in charge (Vaines 13). The respondents in this study demonstrate exactly that point since 77% of the sample were female and reported that they were responsible for household shopping. This point is particularly prevalent with regard to access to cars. In fact over 50% of women in 1991-1993 either lived in households without a car or were non-drivers in a household with a car. Similarly, although there is a rising proportion of women who work they still do most of the shopping and spend twice as much time as men provisioning the household (Piachaud & Webb 18). Ultimately, anything that affects the purchaser also affects the purchasing experience -- in this case physical access to the foodstore. Comparative shopping exercises illustrate the availability and price indices of food and reiterate the price differences between the smaller independents, the local corner shops and the supermarkets. Initial research using the British Ministry of Agriculture, Fisheries and Food's "Low Cost, Healthy Diet" (Leather 75) provides evidence of a cost differential of £1.41, or a 26% cost penalty by shopping at a corner store rather than a superstore. Availability among corner shops similarly compared unfavourably with the supermarkets, with the smallest stores offering minimal fresh fruit and vegetables and regularly offering no 'economy' branded equivalent to an established manufacturer's brand. This supports previous research which found that in areas where small shops do exist they offer only a limited overpriced range of processed foods (Elliott 5), and it is generally accepted that those who can shop at supermarkets can generally benefit from lower prices and more choice (Piachaud & Webb 32). The benefits of supermarkets are not therefore available to all. Shopping diaries further illustrate this point with the dichotomy existing where the lower-income consumer shops more frequently and locally than does her higher-income counterpart and it is these same consumers who patronise the smaller, often more expensive corner shop. Many consumers like the convenience of large supermarkets where they have access to a vast range of items and do not mind paying premium prices on some items for this convenience. Supermarkets do not offer low prices on all items, but do stock economy lines as well as premium priced items. The consumer questionnaire provides some quantitative analysis and statistical weight to the data and was analysed using the χ-square test on SPSS for Windows Version 8. With the χ-square test the important detail is the significance level (reported as a p-value). A p-value of less than 0.05 indicates that the two groups are significantly different at a confidence level of 95% -- in other words, it can be concluded that the author is 95% certain that the result is statistically significant and free from error. Four areas of the Province were sampled -- two rural and two urban. The sample was 77% female and the median age group fell between 45 to 54 years. The social class status was skewed towards the lower socio-economic classes and only 12% fell into social classes A or B. The mean household income was £151 to £200 per week. The survey was interviewer-assisted and pointed to some interesting correlations between levels of satisfaction with store location and distance travelled, product choice and the decision to continue shopping in the town centre. Thirty percent of the sample stated that they shop at off-centre complexes and 70% of the sampled households shop in the town centre or closer to home. This sample also provides evidence that shopping is largely a car-borne activity with 58% of the sample using the family car. Journey distance is significantly influenced by degree of satisfaction with locality: p<0.01 and is supported with the evidence that 64% of the respondents stated that they shop less than fifteen minutes from home. Similar relationships exist between reported satisfaction with locality and differing degrees of satisfaction for product choice: p<0.01. A significant bias similarly exists between those who continue to shop in the town centre after the advent of the UK multiples into Northern Ireland in 1996 and those who do not: p<0.05 with a bias towards those continuing to shop in the town centre reporting high satisfaction levels. Ultimately, perceived adequacy of shopping provision influences satisfaction with store locality: p<0.05. Although the majority of respondents' weekly shopping is conducted at a multiple there is still an identified need for the local corner shops and independents since approximately 29% of respondents buy essentials like bread, milk and other basic grocery provision there. In fact, 98% of those surveyed reported that every town centre should have a food store, and 82% noticed a reduction in the number of food stores locally in recent years. In a concluding open question in the survey attitudes towards off-centre supermarkets were gauged. Responses ranged from positive in nature ("better parking facilities") to indifferent ("I never bother with them") to negative ("they [out-of-town supermarkets] only suit people with cars" and "they hurt the small shopkeeper"). From a retail management point of view, the multiple stores perceive (or want the consumer to believe) that they have a "social responsibility" but suggest that it should be a coalition between retailers and councillors to rejuvenate the town centres and it is not their sole responsibility. The corner shops argue their business position has survived but allude to the fact that the migration to out-of-town sites by the supermarkets has "created a void in the town centre". The issue is complex. While it is true that the multiples have brought shoppers a number of benefits -- price, choice and quality -- they have also both directly (siting shops outside town centres and in high income areas) and indirectly (undermining the economies of small, local outlets) increased costs on disadvantaged consumers in terms of time, physical effort and transport. This has led to a degree of social exclusion amongst certain consumer groups, although this was not quantitatively expressed as significant via the medium of the questionnaire in this preliminary study. It should be remembered that food and mealtimes are imbued with social and cultural meaning (Lang 27) and that "food is a vehicle for social control" (7). In fact food desertification has been likened to the "food equivalent of disconnecting the water supply" (27) and initiatives should be considered to alleviate food poverty and rejuvenate town centres throughout the Province. A multidisciplinary approach is necessary with input from retailers, councillors, health promotion personnel and education bodies to bring about a policy to eradicate this form of social exclusion and disadvantage. References Colquhoun, A. "Food Retailing in Transition: Memories of Traditional Grocer Shops in the 1950s." Strugnell and Armstrong. Elliott, V. "Food Deserts Threaten Health of Poor and Old." Sunday Times 5 Nov. 1997: 5. Lang, T. "Running On Empty." Demos Collection 12 (1997). 25-7. ---. "Food Education and the Citizen: Whose Responsibility?" Strugnell and Armstrong 7. Leather, S. "Less Money, Less Choice: Poverty and Diet in the United Kingdom Today". Your Food: Whose Choice? Ed. National Consumer Council. London: HMSO, 1992. 72-94. McGregor, S. "Globalising Consumer Education: Shifting from Individual Consumer Rights to Collective Human Responsibilities." Strugnell and Armstrong 43-52. Murcott, A. "Is It Still a Pleasure to Cook for Him? Social Changes in the Household and the Family." Strugnell and Armstrong 11. Piachaud, D. and J. Webb. The Price of Food: Missing Out on Mass Consumption." London: London School of Economics and Political Science, 1996. 32. Strugnell, C. J. "Food Deserts: Fact or Fiction." Nutrition and Food Science 6. MCB UP. 349-50. Strugnell, C.J. and G. A. Armstrong, eds. Consumer Education: An International Dimension. Conference Proceedings of the XIXth International Consumer Studies and Home Economics Research Conference. Belfast: University of Ulster, 1999. Vaines, E. "The Sacred Nature of Food: A Family Perspective" Strugnell and Armstrong 13. Citation reference for this article MLA style: Sinead Furey, Heather McIlveen, Christopher Strugnell. "Food Deserts: An Issue of Social Justice." M/C: A Journal of Media and Culture 2.7 (1999). [your date of access] <http://www.uq.edu.au/mc/9910/deserts.php>. Chicago style: Sinead Furey, Heather McIlveen, Christopher Strugnell, "Food Deserts: An Issue of Social Justice," M/C: A Journal of Media and Culture 2, no. 7 (1999), <http://www.uq.edu.au/mc/9910/deserts.php> ([your date of access]). APA style: Sinead Furey, Heather McIlveen, Christopher Strugnell. (1999) Food deserts: an issue of social justice. M/C: A Journal of Media and Culture 2(7). <http://www.uq.edu.au/mc/9910/deserts.php> ([your date of access]).

IntroductionIn the year 2000, a group of likeminded individuals got together and convened the first annual World Barista Championship in Monte Carlo. With twelve competitors from around the globe, each competitor was judged by seven judges: one head judge who oversaw the process, two technical judges who assessed technical skills, and four sensory judges who evaluated the taste and appearance of the espresso drinks. Competitors had fifteen minutes to serve four espresso coffees, four cappuccino coffees, and four “signature” drinks that they had devised using one shot of espresso and other ingredients of their choice, but no alcohol. The competitors were also assessed on their overall barista skills, their creativity, and their ability to perform under pressure and impress the judges with their knowledge of coffee. This competition has grown to the extent that eleven years later, in 2011, 54 countries held national barista championships with the winner from each country competing for the highly coveted position of World Barista Champion. That year, Alejandro Mendez from El Salvador became the first world champion from a coffee producing nation. Champion baristas are more likely to come from coffee consuming countries than they are from coffee producing countries as countries that produce coffee seldom have a culture of espresso coffee consumption. While Ireland is not a coffee-producing nation, the Irish are the highest per capita consumers of tea in the world (Mac Con Iomaire, “Ireland”). Despite this, in 2008, Stephen Morrissey from Ireland overcame 50 other national champions to become the 2008 World Barista Champion (see, http://vimeo.com/2254130). Another Irish national champion, Colin Harmon, came fourth in this competition in both 2009 and 2010. This paper discusses the history and development of coffee and coffee houses in Dublin from the 17th century, charting how coffee culture in Dublin appeared, evolved, and stagnated before re-emerging at the beginning of the 21st century, with a remarkable win in the World Barista Championships. The historical links between coffeehouses and media—ranging from print media to electronic and social media—are discussed. In this, the coffee house acts as an informal public gathering space, what urban sociologist Ray Oldenburg calls a “third place,” neither work nor home. These “third places” provide anchors for community life and facilitate and foster broader, more creative interaction (Oldenburg). This paper will also show how competition from other “third places” such as clubs, hotels, restaurants, and bars have affected the vibrancy of coffee houses. Early Coffee Houses The first coffee house was established in Constantinople in 1554 (Tannahill 252; Huetz de Lemps 387). The first English coffee houses opened in Oxford in 1650 and in London in 1652. Coffee houses multiplied thereafter but, in 1676, when some London coffee houses became hotbeds for political protest, the city prosecutor decided to close them. The ban was soon lifted and between 1680 and 1730 Londoners discovered the pleasure of drinking coffee (Huetz de Lemps 388), although these coffee houses sold a number of hot drinks including tea and chocolate as well as coffee.The first French coffee houses opened in Marseille in 1671 and in Paris the following year. Coffee houses proliferated during the 18th century: by 1720 there were 380 public cafés in Paris and by the end of the century there were 600 (Huetz de Lemps 387). Café Procope opened in Paris in 1674 and, in the 18th century, became a literary salon with regular patrons: Voltaire, Rousseau, Diderot and Condorcet (Huetz de Lemps 387; Pitte 472). In England, coffee houses developed into exclusive clubs such as Crockford’s and the Reform, whilst elsewhere in Europe they evolved into what we identify as cafés, similar to the tea shops that would open in England in the late 19th century (Tannahill 252-53). Tea quickly displaced coffee in popularity in British coffee houses (Taylor 142). Pettigrew suggests two reasons why Great Britain became a tea-drinking nation while most of the rest of Europe took to coffee (48). The first was the power of the East India Company, chartered by Elizabeth I in 1600, which controlled the world’s biggest tea monopoly and promoted the beverage enthusiastically. The second was the difficulty England had in securing coffee from the Levant while at war with France at the end of the seventeenth century and again during the War of the Spanish Succession (1702-13). Tea also became the dominant beverage in Ireland and over a period of time became the staple beverage of the whole country. In 1835, Samuel Bewley and his son Charles dared to break the monopoly of The East India Company by importing over 2,000 chests of tea directly from Canton, China, to Ireland. His family would later become synonymous with the importation of coffee and with opening cafés in Ireland (see, Farmar for full history of the Bewley's and their activities). Ireland remains the highest per-capita consumer of tea in the world. Coffee houses have long been linked with social and political change (Kennedy, Politicks; Pincus). The notion that these new non-alcoholic drinks were responsible for the Enlightenment because people could now gather socially without getting drunk is rejected by Wheaton as frivolous, since there had always been alternatives to strong drink, and European civilisation had achieved much in the previous centuries (91). She comments additionally that cafés, as gathering places for dissenters, took over the role that taverns had long played. Pennell and Vickery support this argument adding that by offering a choice of drinks, and often sweets, at a fixed price and in a more civilized setting than most taverns provided, coffee houses and cafés were part of the rise of the modern restaurant. It is believed that, by 1700, the commercial provision of food and drink constituted the second largest occupational sector in London. Travellers’ accounts are full of descriptions of London taverns, pie shops, coffee, bun and chop houses, breakfast huts, and food hawkers (Pennell; Vickery). Dublin Coffee Houses and Later incarnations The earliest reference to coffee houses in Dublin is to the Cock Coffee House in Cook Street during the reign of Charles II (1660-85). Public dining or drinking establishments listed in the 1738 Dublin Directory include taverns, eating houses, chop houses, coffee houses, and one chocolate house in Fownes Court run by Peter Bardin (Hardiman and Kennedy 157). During the second half of the 17th century, Dublin’s merchant classes transferred allegiance from taverns to the newly fashionable coffee houses as places to conduct business. By 1698, the fashion had spread to country towns with coffee houses found in Cork, Limerick, Kilkenny, Clonmel, Wexford, and Galway, and slightly later in Belfast and Waterford in the 18th century. Maxwell lists some of Dublin’s leading coffee houses and taverns, noting their clientele: There were Lucas’s Coffee House, on Cork Hill (the scene of many duels), frequented by fashionable young men; the Phoenix, in Werburgh Street, where political dinners were held; Dick’s Coffee House, in Skinner’s Row, much patronized by literary men, for it was over a bookseller’s; the Eagle, in Eustace Street, where meetings of the Volunteers were held; the Old Sot’s Hole, near Essex Bridge, famous for its beefsteaks and ale; the Eagle Tavern, on Cork Hill, which was demolished at the same time as Lucas’s to make room for the Royal Exchange; and many others. (76) Many of the early taverns were situated around the Winetavern Street, Cook Street, and Fishamble Street area. (see Fig. 1) Taverns, and later coffee houses, became meeting places for gentlemen and centres for debate and the exchange of ideas. In 1706, Francis Dickson published the Flying Post newspaper at the Four Courts coffee house in Winetavern Street. The Bear Tavern (1725) and the Black Lyon (1735), where a Masonic Lodge assembled every Wednesday, were also located on this street (Gilbert v.1 160). Dick’s Coffee house was established in the late 17th century by bookseller and newspaper proprietor Richard Pue, and remained open until 1780 when the building was demolished. In 1740, Dick’s customers were described thus: Ye citizens, gentlemen, lawyers and squires,who summer and winter surround our great fires,ye quidnuncs! who frequently come into Pue’s,To live upon politicks, coffee, and news. (Gilbert v.1 174) There has long been an association between coffeehouses and publishing books, pamphlets and particularly newspapers. Other Dublin publishers and newspapermen who owned coffee houses included Richard Norris and Thomas Bacon. Until the 1850s, newspapers were burdened with a number of taxes: on the newsprint, a stamp duty, and on each advertisement. By 1865, these taxes had virtually disappeared, resulting in the appearance of 30 new newspapers in Ireland, 24 of them in Dublin. Most people read from copies which were available free of charge in taverns, clubs, and coffee houses (MacGiolla Phadraig). Coffee houses also kept copies of international newspapers. On 4 May 1706, Francis Dickson notes in the Dublin Intelligence that he held the Paris and London Gazettes, Leyden Gazette and Slip, the Paris and Hague Lettres à la Main, Daily Courant, Post-man, Flying Post, Post-script and Manuscripts in his coffeehouse in Winetavern Street (Kennedy, “Dublin”). Henry Berry’s analysis of shop signs in Dublin identifies 24 different coffee houses in Dublin, with the main clusters in Essex Street near the Custom’s House (Cocoa Tree, Bacon’s, Dempster’s, Dublin, Merchant’s, Norris’s, and Walsh’s) Cork Hill (Lucas’s, St Lawrence’s, and Solyman’s) Skinners’ Row (Bow’s’, Darby’s, and Dick’s) Christ Church Yard (Four Courts, and London) College Green (Jack’s, and Parliament) and Crampton Court (Exchange, and Little Dublin). (see Figure 1, below, for these clusters and the locations of other Dublin coffee houses.) The earliest to be referenced is the Cock Coffee House in Cook Street during the reign of Charles II (1660-85), with Solyman’s (1691), Bow’s (1692), and Patt’s on High Street (1699), all mentioned in print before the 18th century. The name of one, the Cocoa Tree, suggests that chocolate was also served in this coffee house. More evidence of the variety of beverages sold in coffee houses comes from Gilbert who notes that in 1730, one Dublin poet wrote of George Carterwright’s wife at The Custom House Coffee House on Essex Street: Her coffee’s fresh and fresh her tea,Sweet her cream, ptizan, and whea,her drams, of ev’ry sort, we findboth good and pleasant, in their kind. (v. 2 161) Figure 1: Map of Dublin indicating Coffee House clusters 1 = Sackville St.; 2 = Winetavern St.; 3 = Essex St.; 4 = Cork Hill; 5 = Skinner's Row; 6 = College Green.; 7 = Christ Church Yard; 8 = Crampton Court.; 9 = Cook St.; 10 = High St.; 11 = Eustace St.; 12 = Werburgh St.; 13 = Fishamble St.; 14 = Westmorland St.; 15 = South Great George's St.; 16 = Grafton St.; 17 = Kildare St.; 18 = Dame St.; 19 = Anglesea Row; 20 = Foster Place; 21 = Poolbeg St.; 22 = Fleet St.; 23 = Burgh Quay.A = Cafe de Paris, Lincoln Place; B = Red Bank Restaurant, D'Olier St.; C = Morrison's Hotel, Nassau St.; D = Shelbourne Hotel, St. Stephen's Green; E = Jury's Hotel, Dame St. Some coffee houses transformed into the gentlemen’s clubs that appeared in London, Paris and Dublin in the 17th century. These clubs originally met in coffee houses, then taverns, until later proprietary clubs became fashionable. Dublin anticipated London in club fashions with members of the Kildare Street Club (1782) and the Sackville Street Club (1794) owning the premises of their clubhouse, thus dispensing with the proprietor. The first London club to be owned by the members seems to be Arthur’s, founded in 1811 (McDowell 4) and this practice became widespread throughout the 19th century in both London and Dublin. The origin of one of Dublin’s most famous clubs, Daly’s Club, was a chocolate house opened by Patrick Daly in c.1762–65 in premises at 2–3 Dame Street (Brooke). It prospered sufficiently to commission its own granite-faced building on College Green between Anglesea Street and Foster Place which opened in 1789 (Liddy 51). Daly’s Club, “where half the land of Ireland has changed hands”, was renowned for the gambling that took place there (Montgomery 39). Daly’s sumptuous palace catered very well (and discreetly) for honourable Members of Parliament and rich “bucks” alike (Craig 222). The changing political and social landscape following the Act of Union led to Daly’s slow demise and its eventual closure in 1823 (Liddy 51). Coincidentally, the first Starbucks in Ireland opened in 2005 in the same location. Once gentlemen’s clubs had designated buildings where members could eat, drink, socialise, and stay overnight, taverns and coffee houses faced competition from the best Dublin hotels which also had coffee rooms “in which gentlemen could read papers, write letters, take coffee and wine in the evening—an exiguous substitute for a club” (McDowell 17). There were at least 15 establishments in Dublin city claiming to be hotels by 1789 (Corr 1) and their numbers grew in the 19th century, an expansion which was particularly influenced by the growth of railways. By 1790, Dublin’s public houses (“pubs”) outnumbered its coffee houses with Dublin boasting 1,300 (Rooney 132). Names like the Goose and Gridiron, Harp and Crown, Horseshoe and Magpie, and Hen and Chickens—fashionable during the 17th and 18th centuries in Ireland—hung on decorative signs for those who could not read. Throughout the 20th century, the public house provided the dominant “third place” in Irish society, and the drink of choice for itd predominantly male customers was a frothy pint of Guinness. Newspapers were available in public houses and many newspapermen had their own favourite hostelries such as Mulligan’s of Poolbeg Street; The Pearl, and The Palace on Fleet Street; and The White Horse Inn on Burgh Quay. Any coffee served in these establishments prior to the arrival of the new coffee culture in the 21st century was, however, of the powdered instant variety. Hotels / Restaurants with Coffee Rooms From the mid-19th century, the public dining landscape of Dublin changed in line with London and other large cities in the United Kingdom. Restaurants did appear gradually in the United Kingdom and research suggests that one possible reason for this growth from the 1860s onwards was the Refreshment Houses and Wine Licences Act (1860). The object of this act was to “reunite the business of eating and drinking”, thereby encouraging public sobriety (Mac Con Iomaire, “Emergence” v.2 95). Advertisements for Dublin restaurants appeared in The Irish Times from the 1860s. Thom’s Directory includes listings for Dining Rooms from the 1870s and Refreshment Rooms are listed from the 1880s. This pattern continued until 1909, when Thom’s Directory first includes a listing for “Restaurants and Tea Rooms”. Some of the establishments that advertised separate coffee rooms include Dublin’s first French restaurant, the Café de Paris, The Red Bank Restaurant, Morrison’s Hotel, Shelbourne Hotel, and Jury’s Hotel (see Fig. 1). The pattern of separate ladies’ coffee rooms emerged in Dublin and London during the latter half of the 19th century and mixed sex dining only became popular around the last decade of the 19th century, partly infuenced by Cesar Ritz and Auguste Escoffier (Mac Con Iomaire, “Public Dining”). Irish Cafés: From Bewley’s to Starbucks A number of cafés appeared at the beginning of the 20th century, most notably Robert Roberts and Bewley’s, both of which were owned by Quaker families. Ernest Bewley took over the running of the Bewley’s importation business in the 1890s and opened a number of Oriental Cafés; South Great Georges Street (1894), Westmoreland Street (1896), and what became the landmark Bewley’s Oriental Café in Grafton Street (1927). Drawing influence from the grand cafés of Paris and Vienna, oriental tearooms, and Egyptian architecture (inspired by the discovery in 1922 of Tutankhamen’s Tomb), the Grafton Street business brought a touch of the exotic into the newly formed Irish Free State. Bewley’s cafés became the haunt of many of Ireland’s leading literary figures, including Samuel Becket, Sean O’Casey, and James Joyce who mentioned the café in his book, Dubliners. A full history of Bewley’s is available (Farmar). It is important to note, however, that pots of tea were sold in equal measure to mugs of coffee in Bewley’s. The cafés changed over time from waitress- to self-service and a failure to adapt to changing fashions led to the business being sold, with only the flagship café in Grafton Street remaining open in a revised capacity. It was not until the beginning of the 21st century that a new wave of coffee house culture swept Ireland. This was based around speciality coffee beverages such as espressos, cappuccinos, lattés, macchiatos, and frappuccinnos. This new phenomenon coincided with the unprecedented growth in the Irish economy, during which Ireland became known as the “Celtic Tiger” (Murphy 3). One aspect of this period was a building boom and a subsequent growth in apartment living in the Dublin city centre. The American sitcom Friends and its fictional coffee house, “Central Perk,” may also have helped popularise the use of coffee houses as “third spaces” (Oldenberg) among young apartment dwellers in Dublin. This was also the era of the “dotcom boom” when many young entrepreneurs, software designers, webmasters, and stock market investors were using coffee houses as meeting places for business and also as ad hoc office spaces. This trend is very similar to the situation in the 17th and early 18th centuries where coffeehouses became known as sites for business dealings. Various theories explaining the growth of the new café culture have circulated, with reasons ranging from a growth in Eastern European migrants, anti-smoking legislation, returning sophisticated Irish emigrants, and increased affluence (Fenton). Dublin pubs, facing competition from the new coffee culture, began installing espresso coffee machines made by companies such as Gaggia to attract customers more interested in a good latté than a lager and it is within this context that Irish baristas gained such success in the World Barista competition. In 2001 the Georges Street branch of Bewley’s was taken over by a chain called Café, Bar, Deli specialising in serving good food at reasonable prices. Many ex-Bewley’s staff members subsequently opened their own businesses, roasting coffee and running cafés. Irish-owned coffee chains such as Java Republic, Insomnia, and O’Brien’s Sandwich Bars continued to thrive despite the competition from coffee chains Starbucks and Costa Café. Indeed, so successful was the handmade Irish sandwich and coffee business that, before the economic downturn affected its business, Irish franchise O’Brien’s operated in over 18 countries. The Café, Bar, Deli group had also begun to franchise its operations in 2008 when it too became a victim of the global economic downturn. With the growth of the Internet, many newspapers have experienced falling sales of their printed format and rising uptake of their electronic versions. Most Dublin coffee houses today provide wireless Internet connections so their customers can read not only the local newspapers online, but also others from all over the globe, similar to Francis Dickenson’s coffee house in Winetavern Street in the early 18th century. Dublin has become Europe’s Silicon Valley, housing the European headquarters for companies such as Google, Yahoo, Ebay, Paypal, and Facebook. There are currently plans to provide free wireless connectivity throughout Dublin’s city centre in order to promote e-commerce, however, some coffee houses shut off the wireless Internet in their establishments at certain times of the week in order to promote more social interaction to ensure that these “third places” remain “great good places” at the heart of the community (Oldenburg). Conclusion Ireland is not a country that is normally associated with a coffee culture but coffee houses have been part of the fabric of that country since they emerged in Dublin in the 17th century. These Dublin coffee houses prospered in the 18th century, and survived strong competition from clubs and hotels in the 19th century, and from restaurant and public houses into the 20th century. In 2008, when Stephen Morrissey won the coveted title of World Barista Champion, Ireland’s place as a coffee consuming country was re-established. 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L. “Old Dublin Clubs and Coffee-Houses.” New Ireland Review VI (1896): 39–44. Murphy, Antoine E. “The ‘Celtic Tiger’—An Analysis of Ireland’s Economic Growth Performance.” EUI Working Papers, 2000 29 Apr. 2012 ‹http://www.eui.eu/RSCAS/WP-Texts/00_16.pdf›. Oldenburg, Ray, ed. Celebrating the Third Place: Inspiring Stories About The “Great Good Places” At the Heart of Our Communities. New York: Marlowe & Company 2001. Pennell, Sarah. “‘Great Quantities of Gooseberry Pye and Baked Clod of Beef’: Victualling and Eating out in Early Modern London.” Londinopolis: Essays in the Cultural and Social History of Early Modern London. Eds. Paul Griffiths and Mark S. R. Jenner. Manchester: Manchester UP, 2000. 228–59. Pettigrew, Jane. A Social History of Tea. London: National Trust Enterprises, 2001. Pincus, Steve. “‘Coffee Politicians Does Create’: Coffeehouses and Restoration Political Culture.” The Journal of Modern History 67.4 (1995): 807–34. Pitte, Jean-Robert. “The Rise of the Restaurant.” Food: A Culinary History from Antiquity to the Present. Eds. Jean-Louis Flandrin and Massimo Montanari. New York: Columbia UP, 1999. 471–80. Rooney, Brendan, ed. A Time and a Place: Two Centuries of Irish Social Life. Dublin: National Gallery of Ireland, 2006. Tannahill, Reay. Food in History. St Albans, Herts.: Paladin, 1975. Taylor, Laurence. “Coffee: The Bottomless Cup.” The American Dimension: Cultural Myths and Social Realities. Eds. W. Arens and Susan P. Montague. Port Washington, N.Y.: Alfred Publishing, 1976. 14–48. Vickery, Amanda. Behind Closed Doors: At Home in Georgian England. New Haven: Yale UP, 2009. Wheaton, Barbara Ketcham. Savouring the Past: The French Kitchen and Table from 1300-1789. London: Chatto & Windus, Hogarth P, 1983. Williams, Anne. “Historical Attitudes to Women Eating in Restaurants.” Public Eating: Proceedings of the Oxford Symposium on Food and Cookery 1991. Ed. Harlan Walker. Totnes: Prospect Books, 1992. 311–14. World Barista, Championship. “History–World Barista Championship”. 2012. 02 Apr. 2012 ‹http://worldbaristachampionship.com2012›.AcknowledgementA warm thank you to Dr. Kevin Griffin for producing the map of Dublin for this article.

ABSTRACT This article examines the bioethical discourse on polygenic embryo screening (PES) in reproductive medicine in blogs and news stories published during 2021 in response to the first baby’s birth using polygenic risk scores (PRS) derived from genome-wide association studies. We further contextualize the findings by synthesizing the emerging peer-reviewed bioethics literature on the issue, which has emphasized considerations regarding the child-parent future relationship, equity of access, and the absence of professional guidelines. Our media content analysis has established that expert opinion was prominently featured in news coverage, with bioethicists and other academics contributing 38 percent of articles and providing extensive commentary on ethical, social, and policy implications in the articles written by journalists. The overall perspective towards the use of PES was primarily negative (59 percent of the articles), without significant differences in negativity and positivity between experts and science reporters. This indicates a shift from the predominantly neutral attitudes towards the technology in media discourse prior to its deployment in clinical settings. There is heightened awareness that offering these tests to prospective parents is unethical and can create unrealistic expectations, with the two most prominent arguments being uncertainty about the prediction accuracy of polygenic risk scores in this context (72 percent of the articles) and the potential of PES to lead to a eugenic future of human reproduction that normalizes the discrimination of people based on their genetics (59 percent of the articles). INTRODUCTION The possibility of using genetic technologies to engineer the perfect baby has long haunted the public imagination. While some techno-utopians have openly advocated for human genetic enhancement, many critics have warned that advances in DNA technology come with myriads of ethical dilemmas and potentially dangerous social consequences. Literary and cinematic works have offered dystopian visions of our genetic futures—from Aldous Huxley’s powerful socio-political fantasy in his book Brave New World (1932) to cult classics of sci-fi cinema, such as Blade Runner (1982) and Gattaca (1997), there has been no shortage of ominous predictions that genetic engineering would lead to a new form of eugenics, which would ultimately create new social hierarchies grounded on genetic discrimination. Moreover, concerns about the use of genetic and genomic technologies for social control have been entangled with deep philosophical questions about personal autonomy, the right of the child to an open future, and the morality of changing, improving, or redesigning human nature.1 The perennial debate on human enhancement was recently reignited with a new controversy over the use of pre-implantation screening of embryos using polygenic risk scores.2 While the profiling of IVF embryos to detect hereditary, monogenetic diseases has been widely accepted, some companies are now pushing the envelope with unrealistic promises of tests that can predict genetic possibilities for desirable traits such as a child’s intelligence, athletic ability, and physical appearance. One event that prompted a public outcry in late 2021 was news about the birth of the first baby from an embryo selected through polygenic testing, a girl named Aurea.3 Although the embryo screening in Aurea’s case was used to decrease the likelihood for certain health conditions, many commentators believed that it signaled a real possibility of embryo selection for non-medical reasons becoming a commercial procedure in the foreseeable future, especially in the largely unregulated US fertility market.4 In the past, there have been discrepancies in how ethical and policy issues arising from advances in reproductive medicine have been viewed by experts (e.g., bioethicists, philosophers, legal scholars) and presented in the news. Like other advances in medical genetics, gene editing and screening technologies have been frequently characterized by exaggeration, sensationalism, and hype around clinical possibilities.5 Moreover, news media have often amplified the anticipated health benefits of genetic testing while overlooking uncertainty associated with its clinical validity and emerging ethical concerns, as shown in a recent study of the media portrayal of non-invasive prenatal testing (NIPT).6 The issue of polygenic embryo screening (PES) initially gained traction in the media in 2017 when the New Jersey biotech startup Genomic Prediction made headlines with claims that its testing technology could identify and avoid implanting embryos with very low IQs.7 The company also claimed that it had the capability to identify embryos with high IQs, although it committed not to offer that procedure for ethical reasons.8 The media coverage of polygenic risk scoring of human embryos between 2017 and 2019 was previously analyzed in a study published in BMC Medical Ethics in September 2021.9 This media content analysis has established that while most news articles were neutral towards the technology, one of the most significant critiques raised by science reporters was the absence of solid scientific evidence for the technology’s predictive accuracy and its practical value in IVF settings. It has also identified five major ethical concerns articulated by science reporters that have also been addressed in the academic discourse and within broader policy debates on reproductive technologies: a slippery slope towards designer babies, well-being of the child and parents, impact on society, deliberate choice, and societal readiness. In this article, we examine the discourse on PES in bioethics blogs, opinion articles, and news stories published in 2021, with a specific focus on reactions to the birth of the first polygenic risk score baby. We compare the perspectives of experts and science reporters to establish their attitudes towards PES, the main ethical themes in press coverage, and the key issues highlighted for a future policy debate. We also juxtapose our findings to the previous study of media coverage to establish if the case of baby Aurea has raised any new issues and pressing ethical concerns. I. Polygenic Embryo Screening in Reproductive Medicine While complex diseases and human traits result from a combination of genetic, lifestyle, and environmental factors, genomic medicine is quickly gaining momentum, and demands for genetic tests in clinical practice have significantly increased. Scans and analyses of genomes from various populations, a research area known as genome-wide association studies, have enabled scientists and researchers to identify genetic differences or variants associated with a particular trait or medical condition. These variants can be combined into a polygenic risk score that predicts an individual’s traits or increased risk for a certain disease. For instance, PES have been used to predict a range of diverse common conditions, from diabetes and cancer to attention deficit issues10 and, in some cases, well-being in general.11 This testing modality relies on the probabilistic susceptibility of individuals to certain diseases to offer personalized medical treatments and inform therapeutic interventions. Polygenic embryo screening uses polygenic risk scores to assess an embryo’s statistical risks of developing diseases (e.g., cardiovascular diseases) and potentially traits (e.g., intelligence, athletic ability, among others) and is performed in an IVF setting. It is currently marketed by several US companies such as MyOme, OrchidHealth, and Genomic Prediction to prospective parents as a method to screen pre-implantation embryos for health and non-health related conditions and is accessible to those who can afford to pay for it. As stated in a recent report on companies bringing PES into reproductive medicine, Genomic Prediction has already made their test for polygenic disorders, LifeView, available to couples. In contrast, Orchid Health has only recently invited couples to an early-access program for their testing technology, and MyOme is still in the process of launching its own test.12 In September 2021, Bloomberg first reported the birth of baby Aurea using screening conducted by Genomic Prediction. She was born after her parents used IVF and subsequently PES to select from 33 candidate pre-implantation embryos in 2020.13 Aurea’s embryo was deemed to have the best genetic odds of avoiding conditions such as breast cancer, diabetes, heart disease, and schizophrenia in adulthood. It is worth noting that Genomic Prediction made the announcement almost one year following Aurea’s birth, thus delaying the media’s reaction to this development and the ensuing bioethical and policy debates. II. Ethical, Social, and Policy Implications Some important ethical, social, and regulatory considerations regarding the development and clinical use of PES have been raised within the academic community. The bioethics literature on the issue, however, appears rather thin, which is not surprising given that prior to 2021, the possibility of using this screening method in clinical practice was largely hypothetical. Other genomic technologies that have enabled polygenic embryo selection, such as whole-genome sequencing and pre-implantation genetic diagnosis, have received more attention from bioethicists, legal scholars, and Ethical, Legal, and Social Implications (ELSI) researchers. Our analysis of the emerging literature has shown that some proponents of PES advocate its current use and go as far as to suggest a permissive regulatory environment for the purpose of outpacing the ethical concerns and potential restrictions once the technology becomes widely available. This approach suggests that embryo selection should be allowed for or against any trait associated with higher odds for better health and well-being in general, often without further discussion of what accounts for wellbeing.14 Scholars applying the principle of procreative beneficence to defend the use of PES have also argued for regulation that addresses issues of justice and equality and expands access to the procedure for those who are currently unable to afford it. By contrast, opponents have argued that the clinical utility of this embryo selection method is yet to be proven, and its current use may create unrealistic expectations in parents, making it an unethical practice to offer the procedure as part of IVF treatments.15 They state that predictive models from PRS have been developed with data from genomes of adult populations. Therefore, extrapolating results for embryo screening, along with the absence of a research protocol to validate its diagnostic effectiveness, is dangerous and misleading.16 Another layer of complexity is added because PRS already faces many translational hurdles that would undermine its predictive value assessment for certain traits or diseases. Scientists have noted that PRS take into consideration the genetic component of a particular trait putting aside the effects of other non-genetic factors, such as lifestyle and environment, which might interfere and influence the calculation of these scores.17 Discussions on the ethics and societal implications of PES in the bioethics literature can be grouped into three distinct categories: 1) relational issues between parents and the future child (e.g., selection as identity-determining, concerns about the instrumentalization of children and the child’s right to an open future); 2) concerns about social justice and equality (e.g., fears about a new eugenics that establishes new social hierarchy, limited access to the technology due to its cost); and 3) implementation and regulatory concerns (e.g., lack of professional guidelines and advertising of PES by private companies). An important ethical implication of PES relates to the well-being of the future child and the way that selecting children based on their genetic make-up might negatively affect the parent-child relationship. This is in line with previously raised ethical concerns in the literature around cloning and pre-implantation genetic diagnosis that by choosing a child’s genetic predisposition, we are limiting to and, in some cases, denying their right to an open future. For instance, the future child’s options would be restricted if parents chose a genetic predisposition to musicality that might interfere with the child’s ability to make certain life choices.18 On a societal level, there are concerns PES may alter social perceptions of what is “normal” and “healthy,” resulting in discrimination and stigmatization of certain conditions.19 Related to this are fears about encouraging eugenic attitudes that can exacerbate discrimination against people with disabilities. Furthermore, one of the main ethical concerns raised is that the growing use of PES might exacerbate societal pressure to use this technology, influencing parents’ decisions to select the embryo with the “best” genetics giving rise to a generation of “designer babies.” 20 Finally, direct-to-consumer marketing and clinical introduction of the technology prior to the publication of professional guidelines and in the absence of scientific validity for its use, as well as without appropriate regulatory oversight, is seen as a premature step that might erode public trust.21 III. News Stories and Expert Commentary on Polygenic Embryo Screening in 2021 We conducted searches on google news using keywords such as “polygenic embryo screening,” “polygenic risk scores,” “baby Aurea,” and “embryo selection” and selected blogs and articles from major news sources (e.g., Washington Post, New York Times, Wall Street Journal, LA Times, Guardian, The Times, etc.). An additional effort was made to collect all relevant articles from prominent bioethics blogs such as the Hastings Center Bioethics Forum, Impact Ethics, Bioethics.net, Biopolitical Times (Center for Genetics and Society), among others. The time period for the study was one year, from January 1 to December 31, 2021. While most coverage occurred after the Bloomberg report on the birth of the first baby using PES, there were a number of news stories and blogs in response to a special report on embryo selection based on polygenic risk scores published in the New England Journal of Medicine on July 1, 2020.22 This report, which has received significant attention in the press, warns that companies that offer genetic services can create unrealistic expectations in health providers and prospective parents through their marketing practices. It has further emphasized the scientific uncertainty around the predictive results of PRS in the context of embryo selection. In general, our search has established that the news media coverage on PES over the past year has revolved around these two events – the NEJM Report and the announcement about the first baby born after PES. In total, we collected 29 publications, of which 12 were blog posts and 17 publications under the general category of “news,” including ten news articles, three opinion pieces/perspective articles, two press releases, and one radio broadcast transcript (see Supplementary Material). IV. Methods for content analysis We utilized an inductive-deductive process to develop coding categories for a systematic content analysis of the blogs and new articles. The first author undertook a close reading of the entire dataset to derive inductively recurrent themes and ethical arguments in the media representations of PES. Based on this preliminary analysis, both authors agreed on the categories for textual analysis. The coding book was further refined by using a deductive approach that incorporates themes that have been previously articulated in the scholarly literature on the issue, particularly questions about the perceived attributes of the test, ethical concerns, and emerging policy considerations. The following categories were used to analyze key issues and attitudes towards PES expressed by experts and science journalists: a. Claims that PES is unethical because it violates the future child’s autonomy. b. Concerns about PES as a step towards eugenics and/or genetic discrimination. c. Defenses of PES with arguments that parents have a duty to give the child the healthiest possible start in life (and reduce public health burden). d. Claims that the science behind PRS-based diagnostics is uncertain, and it will take some time to prove its clinical validity. e. Concerns about the equality of access to PES. f. Arguments that PES can exacerbate ethnic and racial inequality (e.g., that most polygenic scores are created using DNA samples from individuals of European ancestries and predictions may not be accurate in other populations). g. Arguments that PES provides health benefits and can help overcome genetic and health inequalities. h. Concerns about the negative impact that PES may have on the child-parent relationship. i. Arguments about the need for better regulatory oversight of PES. j. Suggestions that there is an urgent need for deliberation and debate on the societal and ethical implications of PES. k. Concerns that patients and clinicians may get the impression that the procedure is more effective and less risky than it is. l. Assessment of whether the article’s perspective towards the use of PES is positive, negative, or neutral. We used yes/no questions to detect the frequencies of mentions in each category, except on the last question, which required a more nuanced, qualitative assessment of the overall tone of the articles. We coded articles as “positive” when the authors viewed the technology favorably and emphasized its potential health benefits over its negative implications. Articles that did not condone the current use of PES and expressed strong concerns about the predictive accuracy of this testing method, its readiness for clinical use, and highlighted its controversial ethical and social implications were coded as “negative.” Finally, articles that simply presented information about the topic and quoted experts on the advantages and disadvantages of using PRS for embryo selection without taking a side or expressing value judgments were coded as “neutral.” Acknowledging the complex polysemic nature of media texts, we took into consideration that support or disapproval of PES may be implicit and expressed by giving credence to some experts’ opinions over others. Therefore, we coded articles that mostly cited expert opinion favorable to PES, or alternatively, presented such views as more credible, as “positive”, while we coded articles that emphasized critical perspectives as “negative.” V. Media Discourse and Expert Opinion On PES We found out that perspectives and opinions by experts were prominently featured in both news (17 articles) and blogs (12 articles). The blog posts in our dataset were written by university professors in bioethics (four articles), academics from other disciplines such as medicine, political science, psychology, human genetics, and neurobiology (four articles), and science journalists and editors (four articles). Furthermore, three of the news articles in influential newspapers and magazines such as The Wall Street Journal, The Washington Post, and The Scientific American were opinion articles or commentaries contributed by academics (e.g., a psychology professor, specializing in personality, individual differences, and behavior genetics, a sociology professor, and a director of research in a graduate program in human genetics). The remaining 14 news articles in our dataset were written by science reporters, editors, or other staff writers. Altogether, experts contributed 38 percent of the media coverage (11 articles) on the issue of PES and its wider societal implications. Experts’ comments were also heavily featured in the 18 articles written by science reporters and other media professionals, which accounted for 68 percent of the dataset. Of these articles, 17 extensively cited experts with academic and research backgrounds (professors and research scientists), seven articles quoted industry representatives (e.g., CEOs and spokespersons of Genomic Prediction and Orchid, other commercial developers), and four articles included opinions by parents seeking PES, particularly Aurea’s father, North Carolina neurologist Rafal Smigrodzki, who argued that a parent’s duty is to prevent disease in their child.23 The overall perspective towards the use of PES was mostly negative – 59 percent (17 articles) expressed negative attitudes, while 24 percent (seven articles) were positive and 17% (five articles) were neutral in tone and did not advance arguments in favor or against the technology and its adoption. However, we did not establish significant differences in negativity and positivity between experts and science reporters. For instance, 49 percent of the articles with negative attitudes were written by experts, while 53 percent were authored by science reports. Similarly, the articles by experts with positive perspectives on PES accounted for 13 percent of the dataset, while science reporters contributed 11 percent of the positive articles. VI. Major Themes and Issues The most discussed issue in media coverage was the prediction accuracy of polygenic risk scores and the uncertainties regarding the utility of these tests in embryo screening. Our analysis has established that 72 percent of the articles (21 out of 29) argued that the science behind PES-based diagnostics is uncertain, and it will take some time to prove its clinical validity. The second most frequently mentioned issue was the potential of PES to lead to a eugenic future of human reproduction. More than half of the articles (59 percent or 17 out of 29) raised concerns that PES could become a step towards a new form of eugenics that could eventually normalize the discrimination of people based on their genetics. Despite concerns about the accuracy of PES testing, many articles gave extensive attention to problems concerning equality of access to PES and related diagnostic services, with 49 percent of the articles (13 out of 29) expressing concerns that the procedure is currently offered at a high cost, it is not covered by health insurance plans, and people of lower socioeconomic status cannot afford it. Furthermore, 41 percent of the articles (12 out of 29) raise concern that the current use of PES reflects the existing ethnic and racial inequalities since most PES are created using DNA samples from individuals of European ancestries, and predictions may not be accurate in other populations. Although it has been reported that Genomic Prediction considers offering the procedure to parents of non-European ancestries, their messaging has suggested it would take a significant time to provide them with predictive models that are as relevant as those for European populations.24 The health benefits of this testing technology, its regulation, and the need for a wider debate on how to realize its promise in a responsible manner were also addressed, albeit to a lesser extent. The potential to overcome genetic and health inequalities by selecting healthy embryos with the best odds against diseases and chronic conditions was emphasized in 41 percent of the articles (12 out of 29). The regulation was a topic covered in 38 percent of the articles (11 out of 29), in which the authors argued that better regulatory oversight of PES is needed, especially in the present condition of an unregulated US market for genetic testing. Additionally, 38 percent suggested that there is an urgent need for deliberation and public debate on the societal and ethical implications of PES. Finally, the issue that patients and clinicians may get the wrong impression that the procedure is more effective and less risky was addressed in 31 percent (nine out of 29). We have established that critical issues about how PES may affect the well-being of the future child and the child-parent relationship have received less attention. For instance, only 17 percent of the articles (five out of 29) supported the clinical use of PES with arguments that parents have a moral obligation to give the child the healthiest possible start in life, a line of thought that is prominent in the bioethics literature on procreative beneficence and procreative autonomy.25 These authors also maintained that the technology has the potential to provide benefits to individuals and reduce the burden of disease and public health expenditure. Similarly, just 10 percent of the articles (three out of 29) expressed concerns about the negative impact that PES may have on the child-parent relationship by causing relational asymmetries between generations and limiting the autonomy of the future child. CONCLUSION Our content analysis has shown that the media discourse on PES and the birth of baby Aurea has been highly influenced by expert opinion. In fact, leading experts from bioethics and a range of other academic disciplines contributed 38 percent of the content in the form of blogs, opinion articles, and commentaries, published on prestigious bioethics fora and in the popular press. Furthermore, as our analysis has shown, science reporters have heavily relied on expert opinion in writing stories about the ethical challenges and societal implications of PES. One important finding of our study is the prevalence of negative attitudes towards the technology, as opposed to past media representations of PES, which had been neutral towards the technology.26 This change in attitudes is likely caused by the amplified voices of bioethics experts reacting to the first clinical use of the technology, which made hypothetical ethical dilemmas a very real possibility. As far as the thematic focus of media representations is concerned, the birth of the first baby using PES has raised ethical concerns similar to those highlighted in the literature on PES and embryo selection through pre-implantation genetic diagnosis, with the most prominent issue being the absence of robust scientific evidence for the predictive accuracy of PRS modeling and its practical value in IVF settings. Although the critical nature of media discourse can contribute to raising public awareness about the ethical acceptability of the technology, bioethicists should also examine the effect of economic forces and societal pressures to have a perfect child that may be driving prospective parents to seek such unproven genetic interventions. PES is an emerging niche in a large, unregulated market for genetic testing services that has the potential to shape the future of reproductive medicine, and there is an urgent need for a policy debate on how it can be developed responsibly and ethically. 1 J. Habermas, "The Debate on the Ethical self-Understanding of the Species," The Future of Human Nature (Oxford, UK: Blackwell Publishing, 2003): p. 16-100. 2 Polygenic risk scores (PRS) are used in personalized medicine to predict disease risk in different human populations, not necessarily for risk modelling in embryos. Polygenic embryo screening (PES), on the other hand, involves the clinical use of PRS modelling from genome-wide association studies of adult populations for selecting embryos with the lowest probability of developing certain health conditions in adulthood. It could potentially be used to select embryos with a higher probability for inheritance of certain physical traits or complex characteristics. 3 C. Goldberg, "Picking Embryos With Best Health Odds Sparks New DNA Debate," Bloomberg September 17, 2021. 4 D. Conley, "A new age of genetic screening is coming — and we don’t have any rules for it," The Washington Post June 14, 2021. 5 K. Kamenova, A. Reshef, and T. Caulfield, "Angelina Jolie's faulty gene: newspaper coverage of a celebrity's preventive bilateral mastectomy in Canada, the United States, and the United Kingdom," Genetics in Medicine 16, no. 7 (2014): 522-28. 6 K. Kamenova et al., "Media portrayal of non-invasive prenatal testing: a missing ethical dimension," Journals of Science Communication 15, no. 2 (2016): 1-19. 7 B. Talat, Choosing the "Smartest" Embryo: Embryo Profiling and the Future of Reproductive Technology, (Canadian Institute for Genomics and Society, March 14, 2019), https://www.genomicsandsociety.com/post/choosing-the-smartest-embryo-embryo-profiling-and-the-future-of-reproductive-technology8 E. Parens, S. P. Applebaum, and W. Chung, "Embryo editing for higher IQ is a fantasy. Embryo profiling for it is almost here.," Statnews, February 12, 2019. 9 T. Pagnaer et al., "Polygenic risk scoring of human embryos: a qualitative study of media coverage," BMC Medical Ethics 22, no. 1 (2021): 1-8. 10 E. L. de Zeeuw et al., "Polygenic scores associated with educational attainment in adults predict educational achievement and ADHD symptoms in children," American Journal of Medical Genetics. Part B, Neuropsychiatric Genetics 165b, no. 6 (2014): 51020. 11 A. Okbay et al., "Genetic variants associated with subjective well-being, depressive symptoms, and neuroticism identified through genome-wide analyses," Nature Genetics 48, no. 6 (2016): 624-33. 12 F. Ray, "Embryo Selection From Polygenic Risk Scores Enters Market as Clinical Value Remains Unproven," (December 22, 2021). https://www.genomeweb.com/sequencing/embryo-selection-polygenic-risk-scores-enters-market-clinical-value-remainsunproven#.YeVWzvhOk2w13 J. Savulescu, "The moral case for eugenics?," IAI News, September 28, 2021, https://iai.tv/articles/the-moral-case-for-eugenicsauid-1916. 14 S. Munday and J. Savulescu, "Three models for the regulation of polygenic scores in reproduction," Journal of Medical Ethics 47, no. 12 (2021): 1-9. 15 F. Forzano et al., "The use of polygenic risk scores in pre-implantation genetic testing: an unproven, unethical practice," European Journal of Human Genetics (2021). 16 Forzano et al., 1-3.; P. Turley et al., "Problems with Using Polygenic Scores to Select Embryos," The New England Jourmal of Medicine 385, no. 1 (2021): 78-86. 17 N. J. Wald and R. Old, "The illusion of polygenic disease risk prediction," Genetics in Medicine 21, no. 8 (2019): 1705-7. 18 M. J. Sandel, "The case against perfection: what's wrong with designer children, bionic athletes, and genetic engineering," Atlantic Monthly 292, no. 3 (2004): 50-4, 56-60, 62. 19 H. Haidar, "Polygenic Risk Scores to Select Embryos: A Need for Societal Debate," Impact Ethics (blog), November 3, 2021, https://impactethics.ca/2021/11/03/polygenic-risk-scores-to-select-embryos-a-need-for-societal-debate/. 20 Pagnaer et al., " 1-8. 21 Forzano et al., 1-8. 22 Turley et al., 78-86. 23 P. Ball, "Polygenic screening of embryos is here, but is it ethical?," The Guardian, October 17, 2021. 24 W. K. Davis, "A New Kind of Embryo Genetics Screening Makes Big Promises on Little Evidence," Slate, July 23, 2021, https://slate.com/technology/2021/07/prs-model-snp-genetic-screening-counseling.html. 25 J. Savulescu, "Procreative beneficence: why we should select the best children," Bioethics 15, no. 5-6 (2001): 413-26. 26 Pagnaer et al., 1-8.