We report the results of underwater archaeological investigations at the submerged Neolithic settlement of Tel Hreiz (7500 – 7000 BP), off the Carmel coast of Israel. The underwater archaeological site has yielded well-preserved architectural, artefactual, faunal and human remains. We examine and discuss the notable recent discovery of a linear, boulder-built feature >100m long, located seaward of the settlement. Based on archaeological context, mode of construction and radiometric dating, we demonstrate the feature was contemporary with the inundated Neolithic settlement and conclude that it served as a seawall, built to protect the village against Mediterranean Sea-level rise. The seawall is unique for the period and is the oldest known coastal defence worldwide. Its length, use of large non-local boulders and specific arrangement in the landscape reflect the extensive effort invested by the Neolithic villagers in its conception, organisation and construction. However, this distinct social action and display of resilience proved a temporary solution and ultimately the village was inundated and abandoned. Coastal environments and their natural resources have attracted human settlement worldwide from as early as ca. 160 ka . SettlemSea levels have changed markedly along the Carmel coast (northern Israel), but the progressive marine transgression and shoreline retreat since 9000 BP is particularly well documented –14. BetwArchaeological analyses of these submerged settlements have demonstrated that there is a correlation between depth and site age. The older sites are found deeper and farther offshore than the younger sites, located closer to the modern-day shore. This also represents a direct correlation between sea-level rise and the abandonment of coastal settlements and their translocation eastward –16. The The submerged Tel Hreiz settlement  was first recognised as an archaeological site in the 1960s, though it has never been systematically excavated . HoweverIn 2012 and 2015, following winter storms, a long, linear boulder-built feature situated at a depth of 3m on the seaward (western) side of the inundated Tel Hreiz settlement was partially exposed. In this article, we demonstrate that the now submerged village was directly associated with this feature, the remains of which we interpret as a seawall. It was deliberately built by the Neolithic villagers and was intended to protect the settlement from waves and marine erosion following post-glacial sea-level rise. The seawall may have worked for a period, however, ultimately it proved futile and the village was eventually abandoned. The Tel Hreiz seawall represents the earliest example of a coastal defence of this type known to date.Over the past four decades underwater archaeological surveys and excavations at submerged Neolithic sites have been carried out along the Mediterranean Carmel coast region of northern Israel . MethodsThe Neolithic sites, including Tel Hreiz, are embedded in a clay palaeosol that is overlain by mobile sands, of varying thickness up to 2m, which serve as a protective overburden. Intentional removal of this sand overburden is a time-consuming and demanding task. As such, the strategy has been to opportunistically survey after storms that remove the sands, naturally exposing the archaeological material. Locations where sites have been identified are surveyed by archaeologists using scuba diving or snorkelling to record exposed areas and material. The location of the exposure features and associated artefacts is documented and planned relative to a set of terrestrial benchmarks and photographed. If necessary, material deemed to be at risk of erosion or illegal collection is then removed. All finds, or groups of finds, are registered and given unique accession numbers.The Tel Hreiz site is located across the intertidal and surf zones on the exposed coast. On average it is covered by 1–1.5 m of mobile sands. Exposure of its remains following a storm is unpredictable and waves interfere, frequently resulting in poor visibility. Documentation surveys, such as that of the seawall and certain features in the site itself, were carried out with scuba equipment at high tide and in calm sea conditions. The exposed features and sensitive archaeological material can erode quickly due to wave action, while cultural material and physical remains may shift or be covered by sand. Thus, work on the site has to be rapid in order to record the maximum amount of information before erosion of the exposed localities. The Tel Hreiz site is regularly monitored, however exposures in 2012 and 2015 provided unusually high movement of overlying sand resulting in significant, previously unobserved exposures.The boulder-built linear feature was first uncovered in 2012 and subsequently in 2015. It lies at a depth of 3m and is usually totally covered by sand. Once uncovered by storms it risks destruction by wave action. After its initial identification in 2012, the exposed section of the wall was measured, drawn to scale and photographed and all features documented within the space of two days. Its precise location relative to the site and terrestrial benchmarks was noted. This was repeated in 2015. Both in 2012 and after its partial exposure again in 2015, it was fully covered by sand within days. Aerial photographic and photogrammetric surveys of the modern beach, coastal ridge and immediate offshore area were undertaken to reconstruct the physical environment of this boulder-built feature as an aid to understanding its function. Areas immediately to the east and west of the wall were surveyed for finds to determine their association with the Tel Hreiz settlement.14C analysis were kept in sea water and in low temperatures (4-7 0C). Faunal and human remains, as well as flints, ceramics, wood and bone artefacts, were soaked in freshwater multiple times to eradicate salts and then dried in the shade. A team of specialists was formed to analyse each of the different find categories: (see acknowledgments).Conservation and preparation of recovered waterlogged material once brought to shore was undertaken in various ways, depending on raw material composition and state of preservation: Waterlogged botanical remains were preserved in freshwater and alcohol solution in sealed plastic jars to prevent contamination and decay. Charcoal and wood for 2 and at depths between 0 and -4m MSL , : no. 1, se posts  25]..14C deteMaterial culture finds recovered from Tel Hreiz comprise numerous flint artefacts , typicalIn addition to numerous unmodified tree branches and a circular ring of woven twigs  no. 14 , hundred14C dates  and some of limestone that are up to 50 to 100 cm in width, 100 cm in height and weigh 200–1000 kg each. The boulders are naturally rounded to sub-rounded and were not cut or quarried. Such boulders do not naturally occur on the site or in its immediate environs (see below).Ephemeral archaeological finds were discovered just seaward of the boulder wall at depths of 3-4m below sea level. These consist of a small hearth immediately adjacent to the boulder wall that is clearly associated with it : no. 2. Structures, such as breakwaters, seawalls and sea embankments are intended to protect a harbour, anchorage, beach or settlement from the effects of weather, longshore drift and the force of the waves. Seawalls and sea embankments are usually built on and parallel to the shoreface or the coast . The earSeveral possible explanations may account for the variation in shape and construction methods used in different sections of the Tel Hreiz seawall: (i) The original land surface was probably uneven, therefore necessitating the use of different building methods to compensate. (ii) Marine erosion could have moved and displaced some of the boulders from their original location. (iii) The disparate sections of the seawall may have been constructed at different times, as inundation of the settlement progressed. (iv) Linked to point (iii), the different building styles may represent repairs or changes to the structure made over time as needed; for example, the thickened, oval-shaped, section of the wall, that may represent a part of the seawall that needed additional strengthening following partial collapse or to compensate for localised erosion.The nearest sources of rounded boulders of this size are the riverbeds and river mouths of the Oren and Galim Rivers, located 3.8km south and 1.6km north respectively from the settlement . NotablyDuring the time of occupation the area to the west of the seawall would have been a swash zone, a beach area that is alternately covered and exposed by up-rush and backwash of waves. This area is therefore exposed to spray and threatened by storm surge and wave run-up. Given its nature, location, and orientation, we propose that the boulder-built seawall was probably constructed to protect the Tel Hreiz settlement from swash-zone encroachment . The locThe conditions in the swash zone make it an unsuitable location for a field , an area for keeping animals , a structure for channeling freshwater (it would have been contaminated by seawater), or a habitation zone. The seawall effectively separates and protects the main part of the settlement, where the concentration of the significant architectural structures and installations were found, from the open sea and from the ancient coastline. Moreover, it does not represent a defensive wall or territorial marker since this would provide little defensive function at the shoreline, while there is currently no evidence that PN settlements in the Southern Levant were walled or fortified, or that territory was defined in this way.Thus, the physical location and setup of the boulder-built wall on the western, seaward side of the Tel Hreiz settlement supports its purpose as a seawall.There are several indicators supporting the contemporarily of the settlement and the seawall. The location and general layout of the wall parallel to the coastline, separating the sea from the main features of the village, indicates pre-planning and a cognizance of its builders of the need to create a barrier to separate the two. If the seawall was built by later inhabitants of the littoral, then one would expect to find associated with it, or between the seawall and the current shore, other structures, cultural and/or organic remains dating to these later periods. However, none have been found despite intensive surveys. Thus, there is nothing to link the seawall to the later terrestrial site of Tel Hreiz located 50-200m east from the current coast, which has historical period strata dating to the last 2500 years. Only items dating to the PN have been found associated with the seawall. The hearth mentioned above : no.12, The closest parallel in the region to the Tel Hreiz seawall is a boulder-built seawall dating to the Late Bronze Age  located in Atlit North Bay, some 3 km south of Tel Hreiz .That seawall, was built of a row of unworked limestone boulders, each approximately 45-60cm in height, at an elevation of 2m above MSL on the seaward (western) edge of the LBA coastal settlement . The LBAThe limestone boulders, though mostly smaller than the older examples at Tel Hreiz, were similarly brought by the LBA villagers to the site from the nearest riverine deposits . They alHaving endured decades of sea-level rise, the Tel Hreiz seawall would have been subjected to some marine erosion. Moreover, following exposure and removal of the sand layer, wave action and storms may have dislodged boulders and stones from their precise original location, especially those that served as the upper courses of the seawall. In contrast, movement of artefacts recovered in the Tel Hreiz settlement and those used for dating the site and the seawall  were all found firmly embedded in the clay paleosol that underlies the mobile sands, and thus were recorded in situ. The clay context is stable until the overlying sand is removed, usually by storms, following which artefacts and other features may rapidly be moved from their original location or destroyed.It has been suggested, that the substantial stone walls found at the Pre-Pottery Neolithic sites of Jericho   and in WHomo out of Africa, the collapse of ancient civilizations) and has resulted in human adaptions or transformations on both the micro and macro-scale [Climate forcing has been implicated as a prime catalyst for many of the biological and cultural milestones in human history  [Current estimates of 210 years) , 60. ThuThe Tel Hreiz boulder wall remnant is unique in terms of its location, size, raw material and construction method and does not fit the proportions or form of any other built structure known to date from contemporaneous terrestrial or other submerged Neolithic sites in the region. It does not appear to represent part of a domestic structure, a terrace wall, part of a dam, corral or an edifice associated with freshwater management. Neither is it a settlement or territorial marker.The numerous unique features relating to the construction of the Tel Hreiz seawall, plus its orientation, size, shape and seaward location relative to the settlement and adjacent to the paleoshoreline, demonstrate that it was unlikely to have been built for another purpose. Moreover, the similarity of finds and evidence of activities inside the settlement as well as adjacent to, and associated with the wall, coupled with the consistency of radiocarbon determinations, all attest to the contemporaneity and association of the wall with the settlement. Finally, the Tel Hreiz seawall closely resembles a later example from the same region, signifying continuity in the practice of building protecting seawalls in coastal settlements of the region over the millennia.S1 FigView from the north see also : no. 3 ((TIF)Click here for additional data file.S2 Fig.(TIF)Click here for additional data file.S3 Figsee also : no. 8. (TIF)Click here for additional data file.S4 Fig.(TIF)Click here for additional data file.S5 Figsee also : no. 13.(TIF)Click here for additional data file.S6 FigView from the north-west .(TIF)Click here for additional data file.S7 Fig(TIF)Click here for additional data file.


The WHO Global Initiative for Childhood Cancer launched in 2018 will translate into an additional one million lives saved or a survival rate of at least 60% for children with cancer to be attained by 2030. This new target represents a doubling of the global cure rate for children with cancer. African children with cancer will be amongst the global group which will benefit from an improved cancer care and better outcome. The landmark event of the year was the launch by WHO of the Global Initiative in Childhood Cancer initiative which was supported by initial funding from St. Jude Children’s Research Hospital in the USA. St. Jude, the first WHO Collaborating Centre on childhood cancer, has committed US$ 15,000,000 to supporting implementation of the initiative. Other prominent organizations, like the American Childhood Cancer Organization and SIOP  announced their support for the WHO InitiativeIn Africa, in 2018, the real incidence or prevalence of childhood cancer is still not known. However, the overall incidence rates might be lower than reported incidence in high income countries due to the fact that almost the majority of the African population (43%) is represented by children. It means that childhood cancer is proportionately more common (4.6% of cancers in sub Saharan Africa v 0.5% in high income countries) [While the survival rate of many childhood cancers surpassed 80% in resource rich countries, in low mid-income countries, where the access to care remains limited, survival rates of 20% or less are not uncommon. However, the mere estimation of the number of children newly diagnosed with cancer every year world-wide does not give any indication of the emotional, social or economic impact of the disease.The credo of Danny Thomas, the founder of St. Jude, was that “no child should die in the dawn of life”. In the spirit of this ambitious goal, the World Health Organization Member States showed their commitment to the 2030 UN agenda for sustainable development including universal health coverage and the access of all children to a basic package of quality and palliative care services. The newly launched initiative, in September 2018, aims at supporting and encouraging governments in assessing the current capacities in cancer diagnosis and treatment with the view of improving the availability of medicines and technologies, analyzing cost and integrating childhood cancer into national strategies, social insurance and health package benefits.The World Health Assembly Resolution 70.12 (cancer prevention and control in the context of an integrated approach) served as a foundation for the newly launched global initiative, which had as shared objective to leverage strong, committed partnerships, technical expertise to identify strategies to address the global childhood cancer burden. It is expected that, as a result of the WHO Global Initiative for Childhood Cancer, a survival rate of at least 60% for children with cancer to be attained by 2030, thereby saving an additional one million lives. This new target represents a doubling of the global cure rate for children with cancer.“Too many children have their lives cut short by cancer, and survival rates in poor countries are scandalously lower than those in wealthy countries,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General.The WHO Initiative was announced right after the Third Global High-Level Meeting on Non-communicable Diseases, where dozens of heads of state and ministers from numerous countries agreed on more urgent action on noncommunicable diseases, which kill 41 million people each year. Their decision gives a renewed impetus to the achievement of the Sustainable Development Goals (SDGs), in particular SDG target 3.4 to reduce premature mortality from noncommunicable diseases by one third, by 2030.AORTIC salutes this important WHO initiative and will support it with all its energy, to transform it into a historical turning point in the fight against childhood cancer.We have learned and continue to learn from the past, through implementing various cancer control initiatives, that accelerated progress can be attained through concerted efforts.AORTIC is dedicated to the facilitation of research and training as well as the provision of relevant and accurate information on the prevention, early diagnosis, treatment, and palliation of cancer, including increasing public awareness of cancer and reducing the stigma associated with it. We strive to unite the African continent in achieving its goal to reduce the cancer burden on the continent and improve outcomes of the cancer patient in Africa through collaboration with health ministries and global cancer organisations.Addressing the cancer burden and its disproportionate impact on developing countries is an urgent task that calls for increased international partnerships and collaborations. A task that AORTIC has undertaken in order to build capacity for cancer advocacy, research and training in Africa.The next AORTIC International Cancer conference, “Cancer in Africa: Innovation, Strategies & Implementation” will take place from 5 to 8 November 2019 in Maputo, Mozambique.


Schistosoma japonicum. The two major factors that have experienced major reductions are the area of snail habitat and the degree of human exposure, both through a variety of mechanisms which differ by region and economic circumstance. However, hotspots of transmission remain. Overall, however, economic development in traditionally endemic areas has provided the resources to carry out projects that have had major beneficial impacts on disease transmission that are likely to be sustainable.Rural development has been a critical component of China’s economic miracle since the start of economic reform in the early 1980s, both benefiting from and contributing to the nation’s rapid economic growth. This development has yielded substantial improvements of public health relevance, including contributing to major reductions in schistosomiasis prevalence. The history of schistosomiasis elimination in Japan suggests that development played a dominant causal role in that nation. We argue that it is highly probable that a similar story is playing out in at least some large regions of China. In particular, we summarize evidence from Sichuan Province which supports the case that economic development has led to improvements in rural irrigation and water supply which, together with changes in crop selection and agricultural mechanization, have all contributed to sustainable reductions in the prevalence of  Rural development has been a critical component of China’s economic miracle since the start of economic reform in the early 1980s, both benefiting from and contributing to the nation’s rapid economic growth. This development has yielded substantial improvements that are of public health relevance including, but not limited to, income and living conditions , infrastructure , roads and transportation networks, services , agriculture , and increasing countryside urbanization  .Yet, development has shown substantial regional disparities, in part due to differences in the underlying economies because the financing of development usually comes from all three levels of governmental administration—central, provincial, and local . For exaS. japonicum in China have met with considerable success [Oncomelania snails, the intermediate host of the parasite. Subsequently, a combination of snail control and the use of praziquantel was widely and effectively used which remains the case today in refractory or re-emergent areas.The public health sector has taken advantage of development in its various aspects, integrating it into schistosomiasis control programs, for example, that are the focus of this report. Viewed first from a national perspective, the longstanding and persistent efforts of the central government to suppress the transmission of  success ,7. In 19In the last decade a comprehensive strategy was implemented that involves a much broader set of interventions mainly focused on environmental determinants of transmission and on bovine populations. During this period, however, disease transmission has periodically re-emerged in a number of settings where control had been achieved . It is nR0, to below unity, the threshold below which disease transmission should continually diminish to zero without further interventions [S. japonicum are likely to be experiencing greater or more sustainable reductions in transmission, and over shorter time spans, than control programs, theory, or earlier epidemiological data would predict. The history of the elimination of S. japonicum transmission in Japan suggests that both agricultural development, and rural development more generally, played a dominant role in their success. We begin with a brief review of the Japanese experience and then turn to the recent experience in Sichuan with the objective of better understanding how best to take advantage of rural development to hasten progress to disease elimination.Our work in irrigated agricultural settings in Sichuan Province has focused on the environmental determinants of transmission and has underscored the need for integrated controls to sustainably reduce the basic reproductive number, ventions ,12. Howeventions . This geventions . The sucA 1996 paper by Tanaka and Tsuji presents an excellent review of the Japanese experience from 1847, when the symptoms of schistosomiasis infection in humans were first reported, to after the last known human cases in 1977 . NotablyOncomelania nosophora snails. Rice-growing areas, marshlands, and river banks were typical snail habitat. By 1920 the role of the snail as an intermediate host of the parasite was established, and control efforts aimed at reducing snail populations had begun. Various means of direct snail control were used over the ensuing years including boiling water, flame throwers, and various chemical mollusicides. Environmental changes that sustainably diminished snail habitat became more common in later years when drainage and water management improvements, including concreting of irrigation ditches and crop changes from rice paddies to orchards all had the effect of reducing snail habitat. The situation was summarized in 1965 by Yokogawa [Oncomelania nosophora was found extended to 18,000 hectares with a farm population of 370,000; by 1966 the breeding area had been reduced to 7333 hectares and the population of farm laborers in danger of infection had dropped to 42,751.”“…..many of the breeding places for vector snails have been removed and cases of schistosomiasis have decreased rapidly to a point where acute cases of schistosomiasis are very rare now. This is no doubt due in part to thorough spreading of molluscicides and the construction of concrete ditches. But certainly major factors have been the decrease in farming area due to urbanization, transformation of farmland into land for building, and conversion of rice fields into orchards or mechanized farms. In 1956 the area in which In Japan there were three major endemic areas and three minor areas. The environmental conditions in all were initially well-hydrated and hospitable to the intermediate host of the parasite, Yokogawa  in addreS. japonicum was understood; the adult worms reside in the vasculature surrounding the liver of the definitive host; each mated female produces copious amounts of eggs, some of which are excreted in the feces of the definitive host and find their way into surface waters where they hatch into free-swimming miracidia. This form of the parasite then seeks an amphibious snail of the species Oncomelania to infect. Successful infection and maturation of the parasite in the snail leads, in turn, to the release of a second free-swimming form, cercariae, which then seek a mammalian host to infect and complete the cycle. The progression of the pathology of the disease depends on the number of worms harbored by the host, referred to as the worm burden, which also controls the number of eggs excreted into the environment. In China the dispersion of eggs into the environment continues to be facilitated by the use of mixed human and animal feces as fertilizer.To understand how development and these various interventions impacted the prevalence and intensity of the disease in both the short and long-term, it is necessary to look more closely at the structure of the schistosomiasis transmission cycle. As mentioned above, by 1920 the basic structure of the transmission of While the causal links between the various elements of the transmission cycle have been long understood, their interaction and impact on the intensity of infection in humans or snails requires a more quantitative description. Here we draw on a substantial history of the use of mathematical models to study various aspects of the time course of the transmission cycle as well as the effects of control strategies, most often mass drug administration (MDA). We have also used models in our studies of the environmental determinants of human exposure and its control. Here we use a community model as a means of describing the mechanisms by which disease transmission is altered by both historical and current control strategies and to explore the impact of rural development in moving from low transmission to elimination. The term community model refers to a differential equation model that tracks the mean worm burden in a human population and the mean density of infected snails residing in their surface water environment. While an individually-based model is more appropriate for quantitative studies at low transmission intensities or to assess stochastic effects, the causal linkages and main effects are the same in both.The most common community model of schistosomiasis transmission is based simply on the concept that the rate of change of mean worm burden in the human population is the difference between the rate at which worms are acquired and mature into adults in vivo and their death rate. Similarly, the rate of change of infected snail density is the difference between the rate of infection of snails by schistosome miracidia and the death rate of these infected snails. A version of such a model that we have used extensively is treated in detail in . Even thR0, is defined for schistosomiasis as the number of female worms reproduced by one female worm during its lifetime in the absence of acquired immunity in the host population. In common with other infectious diseases, if R0 is used in which the time variable parameters are averaged over the annual cycle to derive an effective reproductive number, mS and γ relate to human water contact, Here we cite this model because it allowed the derivation of an explicit expression that includes the important site-specific determinants of the basic reproductive number. Recall that the basic reproductive number, ectively . Both α¯sP and the other directly reduces the population of parasites in the human host or the population of snails, both infected and uninfected. This second type of intervention targets what are termed the state variables of the model rather than the parameters controlling the rates of change of these populations. However, only interventions that alter the parameters, in the present context specifically sP, change effR. For example, well-conducted MDA programs can reduce village worm burden by about 95%, but without altering effR or the underlying R0. It is possible, however, for MDA to terminate transmission, but if R0 > 1, the parasite can be easily reintroduced and the worm burden will begin to rebound towards its endemic level. Similar phenomena, but unrelated to infectious diseases, occur in ecology more generally [A final point of both practical and methodological importance is that interventions to diminish transmission are of two sorts. One type is aimed at reducing the values of the site-specific parameters comprising enerally .sP; and the black line annual chemotherapies until 2008 plus the 50% reduction in sP. While the effective reproductive number, effR, has been reduced by 50% in this hypothetical example, it remains above unity as shown by both the red and blue lines, indicating that re-emergence is possible even after sustained chemotherapies to 2008 if the parasite is reintroduced to the village after that time. The point, however, is that sustainable reductions in sP are necessary to achieve long-term reductions in infection intensity, but chemotherapy of humans and molluscicide use can hasten the time required to reach this reduced level.An example of the effects of the two types of interventions is shown in R0 via changes in sP. Recall that transmission of S. japonicum in Japan had largely been terminated prior to the advent of praziquantel and the literature does not suggest that earlier drugs were used except for strictly medical treatment of advanced cases. Hence, the snail control interventions and/or development-related effects affect five elements of sP which together control the exposure intensity of cercariae and miricidia to which the human and snail populations are exposed. These are the maximum annual density of infected snails, mX, the area of snail habitat, hA, the area of surface water into which cercariae and miracidia are distributed, sA, the population of individuals exposed, n and mS, the maximum annual water contact level of the human population. The parameter sA will not be regarded as an independent intervention target because snail habitat is closely related to surface water hydrology causing a high correlation between the area of snail habitat hA and s.A An exception is the concreting of ditches which reduces hA but leaves sA unchanged. In addition, the two α parameters, which account for the time variation of snail density and water contact, are included for technical completeness.We now return to the Japanese experience with the objective of interpreting that history in the context of its effects on sP thereby affected. Clearly, most of the interventions listed in the table sustainably reduce the area of snail habitat and the extent of human contact with surface waters in the local environment. Since sP depends on the product of hA and mS, an intervention like a change in crops from rice to tree crops, for example, that might reduce both by 50%, would lead to a 75% reduction in sP. In that case, a effR less than 4 would be reduced to less than 1 leading to a continual decrease in infection intensity to the zero state, albeit over a number of years, with no further intervention. While values of effR based on field data are rare, our work in Sichuan suggests that in 2000 the most intensive transmission we observed at the single village level was associated with effR values in the range of 2.5–3.0, which would require decreases in sP of about 60–70% to achieve long-term elimination.S. japonicum can infect 40 or more mammalian species, humans and bovines are regarded as the most important hosts. In China, schistosomiasis transmission is classified as belonging to several different ecological classes. Sichuan falls into the hilly and mountainous class, which is largely comprised of irrigated agricultural land in which a variety of crops are cultivated including rice, tree crops, tobacco, wheat, vegetables, and rapeseed. While The dramatic decline in human prevalence in recent years and the lack of sensitivity of traditional methods of disease surveillance make recent province-wide estimates somewhat unreliable. Clearly hotspots of transmission remain, but their detection is challenging. Further, and not surprisingly, at the provincial level of data aggregation it is difficult to gain much insight into just how reductions in snail habitat were achieved or how increased wealth was utilized to lead to decreases in the prevalence of disease. Hence, we have chosen three counties with different agricultural and economic circumstances to look more closely at their route to disease suppression.Endemic areas in Xichang County represent the typical mountainous transmission environment. The region is characterized by a less-developed economy in comparison with those in the plains and hilly region of the province. Among 26 endemic counties with active transmission in 2008, nine were from mountainous regions accounting for 75% of the mountainous endemic counties. In this type of transmission environment, human prevalence of infection was historically high. Many factors contributed to this, primarily a lack of improved water sources, sanitation, and hygiene (WASH), as well as the wide distribution of intermediate snail hosts along crisscross irrigation ditches in terraced fields where typical environmental management approaches  are challenging to implement. In addition, extensive human exposure due to the nature of agricultural activities was common. Our previous study in Chuanxing and Daxing townships (about 5 × 5 km areas) in 2001 indicated that human prevalence of infection at the village level ranged from 2 to 55% . Typicala massive agricultural structure conversion ,improving domestic water sources for both humans and domestic animals and installing micro-irrigation systems,relocating typically scattered household residences to centralized communities,establishing agricultural corporations with more centralized and managed resources.Pujiang County, in a typical hilly region of the province, is located in the southwest corner of Chengdu Plains. Historically, the endemic level of schistosomiasis was among the highest in the hilly endemic areas. The average human prevalence of infection in endemic villages was around 25% in 1985. The main factors contributing to transmission included water development projects  and relatively large populations of cattle that were the main reservoir of infection. Comprehensive development programs were initiated by the hydrologic and agricultural authorities in late 1990s and early 2000s. Projects focused on: By taking advantage of such developments, public health professionals have worked with the hydrological and agricultural agencies to target high risk environments. As a result, snail habitat was reduced by 98%, from 193,872 ha in 1998 to 5328 ha in 2015 while no new human cases have been found since 2008 .Shifang, located in Chuanbei area, represents a plains type of transmission environment. In the 70s, human prevalence of infection in the endemic villages ranged from 12 to 56%. Because of the more advanced economy in Shifang, in comparison with Xichang and Pujiang counties, the development program has focused on WASH improvement, mechanized agriculture, and development of a rural courtyard economy . As of 2015, the coverage of sanitary toilets, mostly involving biogas digesters, reached more than 65% of households in endemic villages. The county reached transmission control in 1986 and experienced no new human infections since 1999 despite the existence of a relatively large remaining area of snail habitat.sP, of the effective reproductive number for schistosomiasis transmission to near zero in Pujiang county if, as the data suggests, there is no remaining snail habitat and, in particular, no unidentified pockets of Oncomelania snails. A similar reduction in sP is also the case in Xichang and Shifang counties and throughout Sichuan on average, but some habitat remains and hotspots of transmission are not precluded. sP. It is clear from S. japonicum, two disease-specific challenges relate to the involvement other mammalian hosts, notably bovines, and connectivity, the latter referring to social and physical interconnections between host populations of both snails and mammals. The role of cattle and water buffalo in schistosomiasis transmission has long been recognized and surveillance programs continue under the auspices of veterinary authorities. The issue of connectivity, which is of both practical and theoretical importance, suffers from a lack of field data to inform surveillance and control activities. While reasonable estimates can be made of the distance infected humans or bovines might travel beyond their home village, we know of only a single study of the distance cercariae can travel in an irrigation system and remain infective, that distance being greater than 400 m [While we cannot extrapolate with quantitative confidence from Sichuan to other endemic areas of China, similar forces are at work. If the effects are also similar, the endgame is one of identifying and addressing the remaining hotspots of schistosomiasis transmission. This is, of course, easier said than done. Klepac et al. summarize the endgame challenges for infectious diseases in general . In addian 400 m .effR, pertained to a population living in a natural village and farming land adjacent to their residences. In an analysis of data from the 10 of the 20 villages we studied in Xichang County beginning in 2000, we found evidence that only two had effR values consistent with internally sustained endemic infections and that infections in the other eight were likely to have been due to connectivity [In much of our previous work and in the foregoing discussions, the effective reproductive number, ectivity . Gurarieectivity  carried S. japonicum infection survey in suspected residual transmission hotspots, which indicated human infections in most of the 10 villages surveyed  [effR. Based on the distribution of infected humans and bovines, we suspect that these villages include both individual villages with effR > 1, as exemplified in effR values on networks of connected environments.Some insight into the nature of hotspots remaining in Sichuan is offered by findings from a 2016 ication) . None ofS. japonicum in the three counties in Sichuan province over the past 20 years have notable similarities with what we know of the Japanese experience. Rural development that resulted in reductions in snail habitat and diminished human exposure by changes in agricultural characteristics, land-use, and water supply or management are the common factors. We believe the same pattern underlies similar reductions in disease prevalence in the province as a whole and, very likely, in other endemic areas of China. With the exception of molluscicide application, none of these important changes in the rural environment summarized in The reasons underlying the reductions in the prevalence of S. japonicum transmission in those settings because it has supported rural improvements that lead to the sustainable local reductions in the basic reproductive number. A more rigorous analysis of the spatial characteristics of the temporal patterns we have described might offer more generalizable guidance in other environments or for other environmentally-mediated diseases.The similarities between the situations we have described in Sichuan and in Japan suggest that economic development has been a major element of the suppression of We end on a note of caution in that there are other aspects of environmental change that are ongoing and may have less beneficial effects than those discussed above. The lake behind the Three Gorges Dam, for example, links two areas of the Yangtze watershed formerly endemic for schistosomiasis, has stabilized water levels in the Gorges and below the dam and is subject to silting, all of which raise the possibility of substantially increasing snail habitat ,25. Of e


Classification or typology systems used to categorize different human body parts have existed for many years. Nevertheless, there are very few taxonomies of facial features. Ergonomics, forensic anthropology, crime prevention or new human-machine interaction systems and online activities, like e-commerce, e-learning, games, dating or social networks, are fields in which classifications of facial features are useful, for example, to create digital interlocutors that optimize the interactions between human and machines. However, classifying isolated facial features is difficult for human observers. Previous works reported low inter-observer and intra-observer agreement in the evaluation of facial features. This work presents a computer-based procedure to automatically classify facial features based on their global appearance. This procedure deals with the difficulties associated with classifying features using judgements from human observers, and facilitates the development of taxonomies of facial features. Taxonomies obtained through this procedure are presented for eyes, mouths and noses. Humans have especially developed their perceptual capacity to process faces and to extract information from facial features ,2. Our bFor centuries, artists and researchers have tried to develop procedures to measure and classify human faces. Anthropometric facial analysis is used in different fields like surgery –9, forenClassification or typology systems used to categorize different human body parts have existed for many years. In 1940, William Sheldon developed somatotypes to describe the constitution of an individual. Sheldon proposed a classification system in which all possible body types were characterized based on the degree to which they matched these somatotypes . Other tIn the case of facial features, taxonomies are useful, for example, in ergonomics, forensic anthropology, crime prevention, human-machine interaction or online activities. E-commerce, e-learning, games, dating or social networks, are fields in which classifications of facial features are needed. In these activities it is common to use human digital representations that symbolize the user’s presence or that act as a virtual interlocutor . The impSeveral taxonomies of facial features can be found in the literature. For example, Vanezis’s atlas  classifiThis approach, while intuitively logical, has several problems not only in the development of taxonomies, but also in its subsequent use. The classification of facial features is obtained from the opinion of a limited group of human observers. Classic behavioral work has shown that the human brain integrates facial features into a gestalt whole when it processes facial information (holistic face processing) , decreasRecently, analysis of facial images has become a major research topic, and new computational methods for analysis of facial information have been developed. A comparison of these techniques shows two different approaches to deal with facial information . The firClassification methods of facial features are needed in order to develop taxonomies. Research using computational methods is usually focused on the characterization of complete faces. However, less efforts have been made in classification of facial features based on their appearance. In this work, we use an appearance-based method to obtain a relatively low-dimensional vector of characteristics for facial features. On this basis, large sets of three facial features  of varying ethnicity  were characterized. Using this characterization, the features were clustered obtaining new taxonomies for each ethnic group. The procedure followed avoids the problems related to human limitations in classifying facial features. On the one hand, the characterization and clustering of the features were not based on human judgements. On the other hand, classifying new features in one of the groups of the taxonomies can be done in an automatized way. Finally, the procedure was tested comparing human opinions with automatically generated groups of facial features.The next section shows the preliminary process of treatment of images to obtain large sets of facial features from photographs of complete faces. Afterwards, we used eigenfaces in order to characterize large sets of photographs of three facial features . This holistic technique seems to be more consistent and reliable for categorizations than those that imply subjective judgements . The cluOur first objective was to obtain a large database of facial features of different ethnic groups with a neutral expression. Many real face databases are accessible for research purposes , howeverThe available datasets differ in the size and resolution of the images, the pose and orientations of the faces, the uniformity of the background, the illumination, and other important aspects. After reviewing several well-known databases, we selected the Chicago Face Database  to extraThe input of the algorithm for facial feature extraction were all the RGB full-face photographs. Initially, the images were converted to gray-scale. Next, the facial landmarks of each feature  were detected and each feature separately extracted in images of same size for each feature. To achieve this, the CHEHRA facial key-point detector  was usedOnce the features of the faces are available in independent files, each family of them  goes through a set of different operations. The first process performed over the features’ images was an alignment operation. For every feature, a polygon was formed using the previously acquired landmarks and its centroid was computed. Then, all the features were aligned using the previously calculated centroids as reference. After that, the size of the bounding box of the polygon created by the landmarks was computed, and a mask was created to crop all features to the size of the biggest bounding box. By performing this, the cropping rectangle fits the feature itself in the most tight-fitting way possible, discarding as much skin as possible to avoid noise in the clustering step. This procedure was performed for each kind of feature, obtaining the results shown in Before saving them as independent files, eyes and mouths required a special treatment. On the one hand, two eyes were obtained from each face. Except in very particular cases, one person's eyes are highly symmetrical and both must be classified in the same group when using appearance as criterion to cluster the eyes. Therefore, they can be used as an indicator of the correctness of a clustering process, and we decided to use both eyes of each face. To homogenize the appearance of the eyes, left eyes images were mirrored horizontally before saving them . On the The procedure followed to “shave” the mouths was as follows: first, the outer landmarks of the mouth were selected to form a polygon. Then, this polygon was enlarged by 5 pixels in every direction to ensure all the mouth was taken inside the mask. Finally, a Gaussian Blur Filter (sigma = 2)  was applAt this stage, sets of 290 noses, 290 “shaved” mouths, and 580 eyes  were avaOur objective was to develop taxonomies of human facial features in a simple and automatized way; therefore, our criteria to select the most suitable techniques were efficiency and simplicity. We tested different combinations of procedures like eigenfaces, fisherfaces and autoencoders  for featTherefore, eigenfaces were used in order to characterize each feature of each dataset . Finally, the K-Means clustering algorithm  was usedThe eigenfaces approach is a method to efficiently represent pictures of faces by a relatively low-dimensional vector. A principal component analysis can be used on an ensemble of face images to form a set of basis features . These bIn mathematical terms, the eigenfaces method aims to find the principal components of the distribution of faces, or the eigenvectors of the covariance matrix of the set of face images, treating each image as a vector in a very high dimensional space. These eigenvectors (or eigenfaces) can be thought of as a set of features that together characterize the variation between images, and are ordered accounting for the explained variance. Each individual face can be represented exactly in terms of a linear combination of the eigenfaces, or using the "best" eigenfaces . The best M eigenfaces span an M-dimensional subspace of all possible images. Using this procedure over each set of features it was possible to characterize each feature by a set of M eigenvalues, reducing the quantity of information used to describe the features. This holistic approach was selected to characterize the features because the objective was to classify them based on their global appearance more than on their geometrical characteristics . This procedure allow us to consider the global appearance of faces while summarizing the central information to characterize them.The Eigenfaces method was applied over each subset of facial features. To facilitate the subsequent clustering process, the same number of eigenfaces (45) for each subset was selected bearing in mind that the explained variances were about 85% or higher in all cases .At this stage, the appearance of each feature could be characterized using 45 real values . As an example of the information of the features that was captured using eigenfaces, The K-Means clustering algorithm  was seleFour subsets  of three facial features  previously obtained were grouped according to their appearance, measured through 45 eigenvalues, using the K-Means clustering algorithm. In order to determine the most suitable number of clusters, several runs of the algorithm were performed increasing the K from 5 to 30, and the Dunn’s Index for each obtained set of clusters was calculated. The results of iterative clustering algorithms like K-Means can vary depending on the initialization, which consists of selecting random initial positions for the clusters. That could yield different results in each execution; therefore, a round of 10 K-Means runs for each K were performed to check the coherence of the results throughout executions. The experiment was implemented using Matlab R2016a on an Intel(R) Core(TM) i7-4770S at 3.10GHz processor PC with 16 GB of RAM.As an example of how the number of clusters was selected for each subset, In the case of the white mouths, the highest Dunn’s Index was obtained for K = 11 (being SEC number ≤2). https://www.ergonautas.upv.es/lab/facial_features/clusters/).The same procedure was performed for each subset. The codification employed for the features was expanded to classify whole faces considering their features. In this case, the first digit indicates the ethnic group of the face, i.e. A (Asian), B (Black), L (Latino) or W (White). After a hyphen, three groups of three digits express the mouth, nose, and eyes cluster. As an example, in This work proposes an automatic procedure to classify features based on their appearance. This procedure was used to group features of faces extracted from the Chicago Face Database. The intuitively logical approach to validate the procedure is to compare the obtained taxonomies with those generated by human evaluators. However, as aforementioned (Section 1), this last approach has important drawbacks. Classifying a big set of features in an undefined number of groups is a hard task considering human capabilities for information processing ,56. On tInstead of comparing the obtained taxonomies with those generated by humans, we measured the agreement of human evaluators with the proposed taxonomies. The main objectives were: to reduce the number of features presented simultaneously to the human evaluators in order to make a decision, and to simplify the decision that must be made. To do this, a survey composed of several stages was developed. Initially, the image of one feature was selected from the entire dataset in a random way (target feature). Four different representative features were randomly selected (representative features are those designated as representatives of their groups in the obtained taxonomy). In the first stage of the survey the five features were presented to the evaluator in a web form . The tar21 white males and 11 white females aged between 25 and 46 years old participated in three surveys . The Comité de Ética en la Investigación  reviewed and approved these studies. Participants were recruited from May to July 2017 through internal media coverage of the study in the university. Participants gave written informed consent according to the procedures of the Universidad Politécnica de Valencia. The surveys were carried out at the Instituto de Investigación e Innovación en Bioingeniería in Valencia, Spain. In each survey, 200 target features were selected at random from each white features dataset, excluding the representative features. The target features were presented in the survey web form, and the cluster of the representative feature finally selected by the evaluators was registered.Classification systems to categorize human body parts, or taxonomies obtained from them, provide a standardized way to describe or configure the human body, and a lot of work has been done to categorize many different body parts. Describing facial features using a common terminology is essential in disciplines such us ergonomics, forensics, surgery or criminology. Moreover, the growth of new technologies that use virtual interlocutors or avatars has led to an increasing interest in synthetizing faces and facial expressions that symbolize the user’s presence in new human-machine interaction systems and online activities.However, there are very few classification systems or taxonomies for facial features, probably due to the complexity of this task, and to limited human capacity for processing individual features compared to the capacity for processing whole faces. Classifying the appearance of facial features requires a holistic approach that considers all visible information. Therefore, encoding the geometry and carrying out a metric or morphological assessment is not enough to obtain facial features taxonomies based on appearance. In this work, appearance-based representations (Eigenfaces) are used to classify the facial features. The developed procedure forms groups of features taking into account all available information and encompassing their global nature.This procedure was used to classify the facial features of 290 images of males with neutral expression from the Chicago Face Database, obtaining taxonomies of eyes, mouths, and noses for several ethnic groups. To validate the procedure, the agreement of human evaluators with the proposed taxonomies was measured. Out of 200 cases for each feature, 41.0% of mouths, 31.0% of eyes and 46.5% of noses, were classified by humans in the same cluster as in the automatic procedure. More than 73.0% of the features were classified in the expected cluster or in the three clusters closest to it .To the best of our knowledge, there are no similar studies to compare these results. In , the appNevertheless, this study has some limitations. The experiment carried out employed 290 images of males with neutral expression from the Chicago Face Database. Therefore, the taxonomies obtained are only representative of the features of the faces belonging to this database. The representativeness of these taxonomies with respect to other populations must be carefully analyzed before their use. The objective of this work was not to obtain the taxonomies but to develop the automatic procedure to classify facial features based on their appearance. A more comprehensive face database can be used to obtain more representative taxonomies. Therefore, our future work will be focused on increasing the sample size of faces used to develop the taxonomies. At the same time, we will test the performance of the proposed system when classifying new faces not used to develop the taxonomies, comparing the results with the classification of human observers.In the same way, the validation of the proposed procedure was performed for the White facial features. The results obtained for Latino, Asian and Black facial features must be tested, and future work must be done to extend this procedure to other facial features like eyebrows, chins or hair, and to obtain taxonomies of facial features from faces of females.Although judging the similarity of facial features is a subjective process with wide inter-observer and intra-observer variability, the results of the validation survey developed in this work show that the proposed procedure can be considered appropriate for the automatic classification of facial features based on their appearance. This procedure deals with the difficulties associated to classify features using judgements from human observers, and facilitates the development of facial features taxonomies.


These results may be of use for coaches and clubs when recruiting players for each playing position. Older forwards and centers are capable of performing at a higher level. Therefore, clubs have to sign up those players born at the beginning of the year.The Relative Age Effect (RAE) in sport is defined as the age difference in the same sport group. This chronological difference implies a different level of sport experience and performance due to developmental and maturational processes. The aim of the present study was to analyze the relative age effect in elite u-18 basketball according to playing positions. The variables analyzed were: date of birth, playing position and technical-tactical performance indicators in basketball (TTPI). A descriptive analysis was carried out to characterize the sample, a lineal regression was used to analyze the influence of the date of birth on basketball performance and finally an ANOVA and discriminant analysis were performed to identify the differences among different playing positions. The results show the existence of the RAE in the top European Under-18 basketball competition . Performance indicators which are predictors of the birth quarter ( In the sport context in junior categories, the players are grouped by competition organizers according to their birth date which is how the “sport categories/sport levels” are defined. This format is intended to avoid large age differences among players in the same category. In junior basketball the sport categories are made up of players born in two consecutive calendar years. This means that there may be players competing in the same category with up to two years difference in age. This age difference implies more motor experiences in sport and a greater physical and maturational development which permit the achievement of a better sport performance , 2. The Research on the relationship of physiological and anthropometric characteristics of young players is mainly conducted in soccer , 11. DifSome studies have analyzed the distribution of players according to birth date in basketball, but few have examined how the RAE influences players’ performance , 17. DifAnalysis of performance indicators is a consolidated line of research in coaching sciences, providing objective and applicable information for coaches. In basketball, among other studies, the different performance profiles have been analyzed in each of the specific playing positions, point guards, small forwards and centers . The plaTo our knowledge, no studies have analyzed the impact of the RAE according to the specific playing position in basketball, or the relation of the RAE with the players’ performance evaluated using performance indicators according to playing position. Therefore the purpose of the present study was two-fold: i) examine the distribution of birth dates in competitive basketball in the u-18 category, differentiating by playing position and ii) to analyze the effect of the RAE on performance according to playing position using performance indicators.http://www.adidasngt.com/u18). Data would be found in the specific profile of each player for each season and each tournament. Inclusion criteria are the 2013–14 (http://www.adidasngt.com/u18/game-center/standings?seasoncode=JT13) and 2014–15 seasons (http://www.adidasngt.com/u18/game-center/standings?seasoncode=JT14).The sample was composed of all the players who participated in the Adidas Next Generation Tournament, the top European competition in the u-18 category. A total of thirty-two teams participated per season. The format of the competition was organized in 4 regional tournaments . The four champions qualified directly for the Final Four. As well as these teams, the champion from the previous year also qualified directly. The roster was completed by three other teams invited by the tournament organizers, and the event was held in parallel with the Euroleague Final Four. These eight teams competed in two groups and the winning team in each group qualified for the final. All the data were obtained from the official competition webpage: Adidas Next Generation  and classified according to the specific position of guards, forwards or centers [Data were collected from the 2013–14 and 2014–15 seasons . The variables analyzed include the birth quarter of the players , Q2 , Q3  and Q4), the exact age, the specific position of each one, the minutes played and the following performance indicators: points scored, tried and successful two- and three-point shots, tried and successful free throws, total rebounds, defensive and offensive rebounds, assists, steals, turnovers, blocks committed and received, dunks, personal fouls committed and received and Performance Index Rate (PIR). PIR is calculated according the following formula:The cut-off date for young categories of clubs participating in Euroleague basketball is the 1PIR = –.multirater κfree index [Data were collected by the official technicians in each tournament. Nonetheless, data validity was checked using the ee index .Two gameee index , reliabiKolmogorov-Smirnov test [Firstly the performance indicators were normalized and expressed in means per minute of play for each of the players, thus permitting an objective comparison of the sample subjects’ participation. Outliers were cleaned following the procedure stated by Hoaglin and Iglewicz . The disnov test , leadingTo identify if there was a RAE, an exploratory analysis of the frequencies was carried out to describe the RAE for the whole sample and as a function of the specific playing position in each season studied and the overall players. The distribution of players’ birth dates by quarter as a function of playing position was compared by the chi-square test. Also, odds ratios (ORs) and 95% confidence intervals were calculated for both quartile and half years distribution. In each sample, the number of players reported in each quartile was compared with the expected frequency assuming equal distribution . To idenFirstly the results are shown of the analysis of the RAE using the frequencies of each of the specific playing positions as a function of the birth quarter . In caseORs results are presented in p< .05) were found across playing positions. Older guards scored more points and 2-point field goals than those born later. Forward playing positions are related with blocks committed, and centers born early in the year perform and score more 2-point field goals, score more points, receive more blocks and commit more fouls.The correlation coefficient  shows thThe aims of the present study were to examine the distribution of birth dates in competitive basketball in the u-18 category, differentiating by playing position and ii) to analyze the effect of the RAE on performance according to playing position using performance indicators. The results show the existence of the RAE in the Euroleague ANGT in both seasons, with more players being found to be born during the first 6 months of the year. Furthermore, the analyses show a greater predominance of the RAE in the specific guard position. Performance indicators have also been found which differentiate the actions carried out by the players according to their playing position according to birth date.The RAE has often been identified in different sports, with differing effects according to sport discipline or type of competition. The evidence suggests that, although this phenomenon exists, its effect tends to disappears when the level increases , 7, 16 aIn basketball, it is common for guards to be smaller and shorter than the rest of the team. They are the players that organize the team’s offensive play, deciding who should have the ball at any one time; therefore needing a good vision of the court and good passing skills. Finally, guards play most of the time away from the rim and, consequently, they have to develop good field-goal shooting. Centers are usually the tallest players in the team, playing near the rim. Thus, these players need a large body mass to score and defend close to the basket. Finally, forwards are the players with intermediate stature, who have to have good field-goal shooting skills to score away from the rim, and need good conditioning and fitness to help near the basket to rebound and score . In juniThe RAE is more visible in guards than in any other position (ORs and percentages), whereas centers are the players in whom the RAE is less evident. Guards that train more and have greater competitive experience, acquire their performance skills faster than others playing positions, thus height or size is not essential for this position. In contrast, forwards and centers depend more on height and weight to achieve a high performance and participate in elite sport. These qualities are innate and are not attained with training. In university basketball the players who develop as point guards are more important in the game, in contrast to the centers who, because they have to grow taller, take longer to fully develop . AlthougThe RAE also influences performance in playing positions. Statistical analysis shows a relation between guards and points scored, successful 2-point field-goals and PIR, forwards and blocks committed, and centers and points scored, successful and unsuccessful 2-point field-goals, blocks received, fouls committed and PIR. Players with more experience, such as older ones , are ablSome limitations have to be addressed. The maturity status has been proved important in player selection processes. Although the growth process is near to finishing or supposedly finished in this sample (u-18), the study helps to clarify and complete the conclusions on the RAE and players’ development in basketball.The RAE exists in the most important junior continental basketball competition, the Adidas Next Generation Tournament. Guard is the playing position that presents more probabilities of been born in the first half of the year, whereas center is the position that presents less. This way of selecting players is based on advantages related with birth dates; advantages that are smoothed out or eliminated when players achieve full maturation. Also, the qualities necessaries to achieve top level performance as adults do not appear until late adolescence. Results confirm that players’ selection processes are biased negatively for players born at the end of the year. Those players, that have the potential to perform basketball at a high level, are denied access to the best training processes and coaches, hence losing their chances to reach their potential.The results show the need to re-direct talent development processes in basketball. Coaches should consider these results, the RAE should not be overestimated in player selection processes. New criteria should be used to select the talented players, combining their current performance with their potential future performance. Clubs and federations should have development programs that consider that RAE is not decisive for being a high performance basketball player. It has also been shown that birth date affects the playing profile for each playing position. Coaches should use this information to create training and improvement programs which are more suitable and specific for each profile, enhancing the contribution of each player to the overall performance of the team.


Surgery of tongue tumors includes different procedures ranging from mucosal resection to complex combined resection. Numerous terms have been used to describe such procedures, but there is no consensus between the terminology and the extent of resection.We searched the medical literature and found a lack of published information. We undertook to describe a new classification of surgical procedures for tongue tumor resection. We based it upon the surgical anatomy of the tongue and the spread of the cancer. We posited that there were five major types of glossectomy embracing all the methods of tongue cancer resection. This classification was reviewed and endorsed by an international team of experts.We propose a more precise classification than that currently in practice, thereby bringing clarity and consistency to the terminology, facilitating shared communication between surgeons, comparison between published research, and ultimately improving surgical practice and patient care. In 1978, Péri described four types of transoral glossectomy for noncancer‐related diseases of the tongue to reduce tongue volume.However, as yet, no classification exists for defining the extent of tongue resection for tumor removal. A literature search conducted on PubMed  using the terms “glossectomy” and “tongue cancer” yielded over 700 English‐language papers on surgery of the tongue for malignant neoplasms in the human. A thorough examination of the terminology used to define surgical removal of tongue cancers identified the following expressions: glossectomy, partial glossectomy, hemiglossectomy, subtotal glossectomy, transoral glossectomy, total glossectomy, cuneiform glossectomy, and compartmental glossectomy.For the vast majority of these publications, there is no correlation between the term describing the surgical procedure and the extent of the resection carried out: for example, when the terms “subtotal glossectomy” or “hemiglossectomy” are used it is never specified what part of the tongue was removed and what was saved. The lack of a clear anatomical and functional definition of the various glossectomies reported in the literature leads to much confusion and misunderstanding. Such a degree of vagueness in the definition of tongue surgery makes it somewhat difficult to teach and train surgeons, and more difficult still to compare the experiences of different surgeons.The tongue can be considered as a median organ made up of two equal parts, separated from each other by the median raphe. Each half has its own extrinsic muscles  and intrinsic muscles , venous and arterial vessels, and its distinct motor and sensory nerves Figure .Over time, the rationale and technical modalities of resection of tongue cancer underwent evolution. In the last century, most of the early and intermediate staged tongue cancers were treated by a partial glossectomy with margins at about 0.5‐1 cm from the macroscopic limits of the tumor.It follows that surgical treatment of tongue cancers should be planned according to these clinical, pathological, and imaging findings. Early stages can usually be approached via the transoral route as the affected tissue grows and develops on the tongue mucosa or within the intrinsic muscles, and therefore, can be radically excised without necessitating extra‐oral access. When, however, the tumor affects one or more extrinsic muscles which have extralingual insertions, it is necessary to perform an en bloc combined transoral and lateral cervical approach to remove the muscles in toto from their insertions.Accurate preoperative evaluation, a precise analysis of the MRI or CT scan images, and staging using eighth edition of AJCC/Union Internationale Contre le Cancer (UICC)/TNM classification is therefore essential.Starting from the cancer and from the muscles involved, we have developed a classification of glossectomies that clearly and immediately highlights what structures are involved and therefore which type of glossectomy is indicated for achieving a complete removal with minimal functional impact.The aim of this article is to propose a terminology for tongue cancer surgery that is uniform and consistent.We understand that any attempt at classification, especially in the field of tongue surgery, will inevitably be subject to a certain imprecision. A correct classification which not only takes into account all possible variables yet is also sufficiently simple to apply allows a standardized definition of each tongue resection. This is also very useful for education and training, sharing information, and comparing results.This classification developed at the European Institute of Oncology, with long‐term experience in the surgical management of tongue cancer, was reviewed and endorsed by experts from the Memorial Sloan Kettering Cancer Center in New York, The University of Oklahoma Health Sciences Center, United States of America, as well as the A. C. Camargo Cancer Center in Sao Paulo, Brazil. It is based on very precise anatomical and functional components, whose removal depends on the precise nature of the tumor and the surgical anatomy of the tongue; however, to be practical and accepted, it should include the agreement of other surgeons.2Definition: Incision of the mucosa in healthy tissue with appropriate safety margins (1.0‐0.5 cm depending on whether or not the lesion is well defined). The mucosa and submucosa are included up to the intrinsic muscle fibers of the tongue. The deep resection margin should include a thin layer of the intrinsic muscles because of a possible invasion of the submucosa. Generally, the wound is left to heal by secondary intention, although the defect may be partially closed primarily or covered with a skin graft.Indication: Precancerous, superficial suspicious lesions, limited to the epithelium of the tongue without previous biopsy. The aim of surgery is to remove all the lesion with adequate margins up to the healthy tissue with both diagnostic and curative intent Figure .3Definition: It includes the lesion and adjacent normal mucosa, submucosa, and the intrinsic muscles up to the surface of the extrinsic muscles (when the directions of the muscle fibers change), with appropriate safety margins (approximately 1.5 cm). The resection usually is diamond shaped on the surface, while more deeply, it is shaped like a truncated cone with the intrinsic muscles as the apex. The terminal branches of the lingual artery should be ligated and the lingual nerve is usually preserved. Closure may be partial or total with the objective of avoiding bleeding, postoperative edema, and retracted scars.Indication: Lesions infiltrating submucosa and superficially into intrinsic muscles, but not extrinsic muscles, or infiltration less than 10 mm deep44.1Definition: The specimen includes the mucosa, submucosa, and intrinsic and extrinsic muscles ipsilateral to the lesion. The mucosa is resected up to healthy tissue with appropriate safety margins (at least 1.5 cm); the lingual artery must be ligated and removed en bloc with the lingual and hypoglossal nerves, in the specimen of the primary tumor and neck nodes. The base of the ipsilateral tongue is preserved. The tip of the tongue can be preserved or not.Indication: lesions infiltrating the intrinsic and minimally extrinsic muscles or infiltration greater than 10 mm but confined within the ipsilateral tongue4.2Definition: The specimen includes the mucosa, submucosa, intrinsic and extrinsic muscles ipsilateral to the lesion, genioglossus, hyoglossus and styloglossus muscles, and the inferior portion of the palatoglossus muscle. Medially, the midline raphe is included in the resection. The lingual nerve is resected as far cranially as possible. The hypoglossal nerve is removed after the ansa, the lingual artery and vein is ligated in proximity to the horn of the hyoid bone, and removed en bloc with specimen and neck nodes.Indication: Lesions massively infiltrating the intrinsic and extrinsic muscles but confined to the ipsilateral tongue Figure B.55.1Definition: This is an anterior subtotal glossectomy with preservation of both sides of the base of the tongue, posterior hyoglossus muscle, and hypoglossal and lingual nerves, from the less involved side.Indication: Lesions that arise in the anterior portion of the mobile tongue and exceed the hemilingual area of origin involving the contralateral genioglossus muscle but limited to mobile tongue Figure A.5.2Definition: Type IVa glossectomy with extension to the ipsilateral base of the tongue. The following contralateral structures are preserved: hyoglossus and styloglossus muscles, hypoglossal and lingual nerves, and lingual artery .Indication: Massive lesions that exceed the border of the hemilingual area of origin infiltrating the ipsilateral base of the tongue and the contralateral genioglossus muscle Figure B.6Definition: The specimen includes all of the mobile tongue and the base of the tongue transected at the level of the vallecula; it includes intrinsic and extrinsic muscles, both lingual arteries, hypoglossal, lingual nerves, and the floor of the mouth.Indication: Massive infiltrating lesions, for instance, those of the anterior ventral surface of the tongue, dorsum of the tongue, or the tongue base, which bilaterally involve the extrinsic genioglossus, hyoglossus, and styloglossus with impairment of the mobility of the tongue Figure .Depending upon the extent of the lesion, type III‐V glossectomies can be extended to some of the adjacent structures such as the geniohyoid muscle, digastric muscle, the epiglottis, all the larynx, the lateral wall of the pharynx, or the mandible. In such cases, the type of resection should be termed “glossectomy type extended to…” When, however, the type of glossectomy envisages that a structure be resected, but in fact the structure is preserved, the terminology applied in such a case should be “glossectomy type…” with the additional designation “with preservation of…”7The tongue is an organ of communication, speech, and articulation and is the principal structure that shapes and controls the food bolus during chewing and swallowing. It is a complex muscular structure covered with a specialized mucosal layer, anatomically comprising twin structures such as muscles, veins, arteries, and a nerve supply that join together in the lingual septum.From the surface downward, we find the mucosa, submucosal, and muscular layers which include the intrinsic muscles, whose fibers have insertions only into the tongue itself, and the extrinsic muscles that arise from adjacent anatomical structures .Neoplasms can affect one or more of the above‐mentioned layers and the TNM classification of malignant tumors, the most commonly used cancer staging system, classifies them on this anatomical basis. The eighth edition of the AJCC/UICC TNM classification divides tongue tumors into early, intermediate, and advanced stages according to the depth of invasion of one or more of the four layers, from the surface inward, in addition to surface dimensions.We realized the need for a shared and unified terminology, on re‐examining our own case records, in which we discovered that a range of different terminologies had been employed to refer to the very same surgical interventions. To clarify such confusion, we decided to base our proposal on the surgical anatomy of the tongue.Other classifications of surgical procedures are reported in the literature, not only in the field of head and neck surgery but also in other fields in an attempt to create a common unifying language and to make such techniques more reproducible and comprehensible.Considering the current wide acceptance of “compartmental” surgery for tongue cancer,The purpose of this work is not to enter into the merits of the indications of the neck dissection. Nor does it aim to explore the details of the reconstructive techniques used to repair the surgical defect. We limit ourselves to underline that, in general, type I glossectomy should not require prophylactic neck dissection. In type II glossectomy, supraomohyoid neck dissection should be carried out based on the probability of occult metastases and according to the institutional and international guidelines. From the type III glossectomy onward, the dissection of the neck should be done as an en bloc procedure. In the type IV and V glossectomies, the en bloc resection should be performed with bilateral neck dissection. In brief, the extent of tongue resection—type of glossectomy—is a reflection of the three‐dimensional extent of the primary tumor, and thus would entail the need for elective neck dissection based on the rising risk of occult metastases in the clinically negative neck.The objective of this classification is to provide precise anatomical coordinates which will enable the techniques to be uniformly standardized, thereby rendering them repeatable and comparable. This will also provide the pathologist with detailed anatomical information. We believe that this kind of classification could help us even in the planning of the reconstructive time .8Based on our own experience and the published literature regarding the various types of glossectomy employed in tongue cancer surgery, we wish to propose a more precise and informative classification than what is currently in practice. It is based upon the surgical anatomy of the tongue which comprises also the routes of spread of the tongue cancer. Our proposal is to classify the surgical procedures for tongue cancer into five types, on the basis of well‐defined structures to be excised. The terminology describing each type of glossectomy must also indicate the surgical access employed.