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Dans cet article, nous proposons, dans le cadre d’une recherche-action, une approche d’amélioration des processus hospitaliers basée sur l’identification des étranglements. L’objectif est de rationaliser les processus hospitaliers afin d’accélérer les flux et fournir des services de haute qualité aux moindres coûts. L’approche combine le Business Process Management et le Lean Management pour tirer profit de leurs forces respectives. En procédant d’une façon descendante, nous avons commencé par identifier et classer les processus du service d’urgences du CHU Charles Nicolle à Tunis, Tunisie. Ensuite, nous avons formalisé le processus de prise en charge des patients pour dresser une cartographie de la chaîne de valeur permettant d’identifier et de quantifier les activités sans valeur ajoutée, principalement les attentes et les déplacements inutiles. Cette cartographie a révélé deux principaux goulots ainsi que l’importance de la coordination et de la mise en place d’un système efficace d’information et d’aide à la décision. Un tel outil devrait permettre de décloisonner les différents services du CHU tout en permettant de synchroniser les différentes activités afin de le piloter d’une façon plus efficace.

In response to a global movement demanding justice for historically oppressed communities, there are increased calls for transitional justice approaches to help unravel legacies of colonization, slavery and marginalization. Applying transitional justice approaches to contexts of structural injustice raises new questions that push the boundaries of the field. In the face of these challenges, this article explores ways to conceptualize transitional justice as a dynamic, ongoing relational process that centers victims and involves bystanders, beneficiaries and the general public in meaningful and appropriate ways. Across different socio-political contexts, we look to new voices, in particular youth voices and creative approaches, for inspiration on how to bring more people into the conversation to address emerging dilemmas in consolidated democracies. Much can be learned from the dynamic spaces created by young people to encourage a more transformational process of reckoning with past legacies to advance a more just future.

Attack paths are the potential chain of malicious activities an attacker performs to compromise network assets and acquire privileges through exploiting network vulnerabilities. Attack path analysis helps organizations to identify new/unknown chains of attack vectors that reach critical assets within the network, as opposed to individual attack vectors in signature-based attack analysis. Timely identification of attack paths enables proactive mitigation of threats. Nevertheless, manual analysis of complex network configurations, vulnerabilities, and security events to identify attack paths is rarely feasible. This work proposes a novel transferable graph neural network-based model for shortest path identification. The proposed shortest path detection approach, integrated with a novel holistic and comprehensive model for identifying potential network vulnerabilities interactions, is then utilized to detect network attack paths. Our framework automates the risk assessment of attack paths indicating the propensity of the paths to enable the compromise of highly-critical assets (e.g., databases) given the network configuration, assets' criticality, and the severity of the vulnerabilities in-path to the asset. The proposed framework, named SPGNN-API, incorporates automated threat mitigation through a proactive timely tuning of the network firewall rules and zero-trust policies to break critical attack paths and bolster cyber defenses. Our evaluation process is twofold; evaluating the performance of the shortest path identification and assessing the attack path detection accuracy. Our results show that SPGNN-API largely outperforms the baseline model for shortest path identification with an average accuracy >= 95% and successfully detects 100% of the potentially compromised assets, outperforming the attack graph baseline by 47%.

Vitiligo is a multifactorial dermatosis with many etiological hypotheses that have been suggested for its occurrence. To our knowledge, few epidemiological studies are available on vitiligo induction factors and particularly on the role of exposure to chemicals in the onset of the disease has been found. Therefore, there is need to investigate the relationship between vitiligo and chemical exposures in order to understand this mysterious disease. We conducted a case-control study of patients with vitiligo whose diagnosis was made by a specialist in dermatology. The total study period was of 6 months extending from 1 July to 31 December 2019. The minimum sample size was determined as 46 cases and 92 controls. The control group was gender, age, and professional status matched to the vitiligo group. In the binary logistic regression model, household chemicals/colored toothpaste use, a history of a repeated antibiotic use, and an occupational exposure to phenol/catechol derivatives were significantly associated with vitiligo (three to fourfold increase). Our results suggest that chemical factors play a key role in the occurrence of vitiligo. Therefore, prevention of this dermatosis requires the identification of exposure to the incriminated chemicals in any patient followed for vitiligo. The earlier the diagnosis of 'chemical' or chemically aggravated vitiligo, the better the prognosis for this disease.

Occupational cutaneous squamous-cell carcinoma has an increased incidence, but rarely suspected. When located in an uncovered skin area, it is closely linked to polycyclic aromatic hydrocarbons exposure. However, single pulmonary anthracosis nodule is rarely described in the literature. The association of both diseases due to the same exposure remains uncommon.

By bringing smart and advanced solutions, the Internet of Things (IoT) has opened up new dimensions of innovative services and processing power for contemporary living standards. IoT has a wide range of devices and communication entities as a result of the widespread applications of these services, making network management a challenging task. Therefore, it is critical to redesign the IoT network’s management. The inherent programmability and centralized capabilities of software-defined networking (SDN) make network management simpler, enable network abstraction, make network evolution easier, and have the potential to handle the IoT network. However, security issues still present the IoT dilemma. Distributed Denial of Service (DDoS) attacks are among the most significant security threats in IoT systems. This paper studies in-depth DDoS attacks in IoT and in SDN. A review of different detection and mitigation techniques based on SDN, blockchain and machine learning models is conducted. A holistic, secure IoT system is proposed on the basis of SDN with multicontrollers. Blockchain is considered to guarantee security in distributed SDN-IoT networks and ANN to improve the detection and mitigation process.

Purpose This study aims to examine the influence of accounting professionals’ Machiavellian behavior and ethical judgments on their intention to report fraudulent acts and also to examine the moderating effect of Machiavellianism on the relationship between professionals’ ethical judgments and whistleblowing intention, as well as the mediating effect of personal responsibility, personal costs/benefits and the seriousness of the questionable act on this relationship. Design/methodology/approach The data were collected via a survey sent to 201 Tunisian accounting professionals and analyzed using the structural equation method. Findings The results indicate that ethical judgments support the whistleblowing intentions among Tunisian accountants. However, this relationship is affected by Machiavellian behavior that minimizes whistleblowing. Furthermore, the results show that Machiavellianism is negatively associated with whistleblowing intention and has an indirect effect on whistleblowing through perceived personal benefit and the seriousness of the questionable act. Originality/value Examining the ethical ideologies that may affect whistleblowing, including Machiavellianism and ethical judgment, in the Tunisian context contributes to the literature on the accounting profession in the Middle East and North Africa. The results of this study could raise awareness among policymakers and regulators in developing countries, particularly in Tunisia, to value whistleblowing as a mechanism for detecting and controlling organizational misconduct and enact regulations that encourage accounting professionals to report fraudulent acts while protecting them.

The surgical treatment of lumbar degenerative spondylolisthesis (LDS) remains controversial. The aim of this study was to determine the effect of adding transforaminal lumbar interbody fusion (TLIF) to posterolateral fusion (PLF) on the local lordosis, sagittal alignment and potential complications. The second aim was to evaluate the effect of slip reduction on the same parameters.The initial hypothesis was that TLIF provides better correction of the local lordosis and that reducing the slip improves the global sagittal balance.In this retrospective, single-center study, patients who had been operated on for LSD at one or two levels by laminectomy and PLF, with or without a TLIF cage, were included. Data collected consisted of age, sex, number of levels fused and whether or not a TLIF cage was used. Fusion was defined as the absence of indirect nonunion signs on radiographs at 2 years postoperative. The occurrence and time frame of any complications and the need for reoperation were documented. Lateral radiographs of the entire spine were analyzed preoperatively, in the early postoperative period (3 to 6 months) and at a minimum follow-up of 2 years. The following parameters were measured: pelvic parameters, C7 sagittal tilt (C7ST), spinosacral angle (SSA), maximum lumbar lordosis (LL), lordosis at slipped level (LS), slip percentage. The analysis compared patients treated by PLF and TLIF and determined the impact of slip reduction.One hundred three patients were included in the study (71% women). The mean follow-up was 38 months. The mean age was 69 years. Seventy-seven patients (75%) underwent PLF. Comparing the preoperative and early postoperative data identified 5.4% better spondylolisthesis reduction in the TLIF group than the PLF group (-8.9 ± 9.5% vs -3.5 ± 7.6%; p=0.04) that was not maintained at the final follow-up. The fusion rate was comparable between groups: 94% in APL and 89% in TLIF (p=0.7). The overall complication rate was 46% in the TLIF group versus 33% in the PLF group (p=0.35). A comparison based on whether or not the slip was reduced found significant improvement in the reduction group of the SSA by more than 6° (6.8° ± 6° vs 0.5° ± 7.4°; p=0.04). The fusion rate was 91% in the reduced group and 95% in the non-reduced group (p=0.81); the complication rate was 44% versus 28% in the non-reduced group (p=0.10).This study shows that slip reduction helps to improve the sagittal alignment by increasing the SSA when treating LDS. Posterolateral fusion and TLIF produce comparable radiographic outcomes at 2 years postoperative in the segmental lordosis, slip reduction, global sagittal alignment and fusion rate.IV.

Introduction: The aim of this study was to evaluate torsional, dynamic, and static cyclic fatigue resistance of the reciprocating One RECI (OR; Micromega, Besançon, France), WaveOne Gold (WOG; Dentsply Maillefer, Ballaigues, Switzerland), rotary One Curve (OC, MicroMega), and ProTaper Next X2 (PTN X2; Dentsply Sirona, Charlotte, NC) instruments. Methods: A total of 120 OR (n = 30), WOG (n = 30), OC (n = 30), and PTN X2 (n = 30) nickel-titanium instruments were used. Torque and rotation angle until failure under static torsion loading were measured according to ISO 3630-1. Static and dynamic fatigue resistance was measured as the time to fracture in an artificial stainless steel canal with a 60° angle and 5-mm radius of curvature at intracanal temperature. The results were analyzed with 1-way analysis of variance and the post hoc Tukey test. The alpha-type error was set at 5%. Fracture instruments from torsion and fatigue tests were examined with a scanning electron microscope. Results: OR showed higher static fatigue resistance and rotation angle at fracture than WOG, OC, and PTN X2 (P < .05). WOG exhibited higher torsional resistance than the others (P < .05). The cyclic fatigue tests in dynamic mode had higher TTF than static for the PTN X2 and WOG groups (P < .05). In the dynamic tests, OR and WOG showed higher TTF than OC and PTN X2 (P < .05). Conclusions: Under these experimental conditions, One RECI exhibited suitable mechanical properties with the highest cyclic fatigue resistance and angle of rotation among the tested instruments. Keywords: Continuous rotation; One RECI; cyclic fatigue resistance; reciprocating motion; torsional resistance.

Workaholism is an emerging form of behavioural addiction encountered in the workplace. The present study aims to assess the prevalence and the associated factors of this phenomenon in engineers.A cross sectional survey was conducted for two months by means of an online questionnaire of engineers practising in Tunisia. The evaluation of workaholism was based on the WART questionnaire (Work Addiction Risk Test).A total of 107 engineers have answered the questionnaire. The mean age of participants was 29.2±4.4 years. Computer engineers represented 32.7% of our sample. Most of engineers worked more than 8hours per day (45.8%) and less than 6 days per week (63.6%). A high risk of workaholism was noted in 42.1% of cases. Statistical analysis showed that workaholism was not associated with socio-demographic characteristics. However, it was associated with smoking cigarettes, psychotropic drug consumption and poly-addiction and inversely associated with the presence of a leisure activity. With regard to occupational factors, workaholism was associated with agronomic engineering, working more than 8hours per day, working the whole week and a job satisfaction score under 5/10.Workaholism interested a significant proportion of this sample, and several professional factors could increase the likelihood of adopting this behaviour. The intervention of occupational doctors seems important in order to raise awareness about this form of addiction and to identify its early signs among employees.

Essential oils are well known to act as biopesticides in pest management programs. The main purpose of this research is to explore the insecticidal potential (fumigant and repellent toxicity) of binary mixtures of essential oils extracted from leaves of three Mentha species namely Mentha rotundifolia, M. viridis and M. longifolia collected from north Tunisia against adults of the rice weevil Sitophilus oryzae. Gas chromatography-mass spectrometry analyses revealed quantitative and qualitative variations among oils chemical composition. Three common compounds β-pinene (0.37–1.06%), α-limonene (0.32–18.39%) and pulegone (0.54–68,057%) were detected. Results showed that when applied alone, the oils exhibited a strong gradient of toxicity with M. rotundifolia being the most effective (CL50: 7.67 μL/L air) compared to M. longifolia (CL50: 12.32 μL/L air) and M. viridis oil (CL50: 100.16 μL/L air). In essential oils binary mixtures experiments, the combination M. rotundifolia x M. viridis exhibited the strongest insecticidal activity (CL50: 8.19 μL/L air) followed by M. rotundifolia x M. longifolia (CL50: 12.49 μL/L air) and M. longifolia x M. viridis (CL50: 19.36 μL/L air). Repellent toxicity was highly dependent upon oils binary mixture and concentrations. The mixture M. longifolia x M. viridis was more effective (PR = 40% at the concentration of 0.032 μl/cm2). Overall, this work demonstrates the interest of combing essential oils as a promising alternative to control S. oryzae in storage. This work promotes operating technologies of essential oils to better guide the biopesticide industry towards a sustainable development path.

Objectives: This study was conducted to determine frequency of contraceptive use, reasoning for not using any method and complications of various methods among low socioeconomic section of society. Study Design: Cross Sectional Observational study. Setting: Department of Obstetrics and Gynecology, Farooq Hospital, Westwood Branch, Lahore. Period: From 1st July 2019 to 31st December 2019. Material & Method: All married women between 18-40 years of age,having at least one child, presenting to gynae outdoor, were included in the study. Sample size was 408. Mean and standard deviation calculated for age and parity. Frequency and percentage of remaining variables calculated by using SPSS version 16. Results: Out of total 408 participants, 48.3% were in age range of 21-30 years and 86.5% were having parity of ≥ 2. 47.5% participants were illetrate and 52.5% were having different level of education. 53% participants were not using any contraception and only 47% were practicing contraception. Most commonly used method among users were interval IUCD (32.3%) and barrier method (30.2%). Least common method used was Implanon (1.04%). Most common reasons among nonusers were lack of knowledge (30.5%) and fear of side effects (21.7%). Least common reasons were myths and false beliefs (8.8%). Common complications among users were menstrual irregularity (29.6%),vaginal discharge (12%) and failure of method leading to conception (7.8%). Conclusion: There is need for strong implementation of government family planning policies and motivation of couples through media and health personnel to achieve effective use of contraceptives.

Resume Objectif Nouer une alliance therapeutique est indeniablement un element fondamental dans la demarche therapeutique. Nous nous proposons d’etudier les differents facteurs pouvant influencer l’empathie du medecin notamment sa personnalite. Methode C’est une etude transversale realisee aupres des medecins de famille de la sante publique exercant a Sfax. Nous avons recueilli les donnees personnelles et professionnelles a l’aide d’un questionnaire preetabli. Nous avons utilise l’echelle Jefferson d’empathie et l’echelle « Big five » pour l’etude de la personnalite. Resultats L’âge moyen des medecins a ete de 45,35 ans. La moyenne des scores d’empathie a ete de 96,24. Nous avons trouve que la pratique d’activite de loisir a ete le facteur le plus predictif de l’empathie clinique (p = 0,03, β = −0,254, R2 = 24,1 %). La pratique d’activite de loisir, la charge des enfants et le temps consacres a l’entourage y ont ete associes (p = 0,005, β = −0,328 ; p = 0,042, β = −0,324 et p = 0,015, β = −0,287). Le fait d’avoir des connaissances en psychotherapie a ete significativement associe a la dimension « prise de perspective » (p = 0,012, β = −0,298, R2 = 30,4 %). Le nombre d’heure de travail a ete le facteur predictif de la dimension « se mettre a la place du patient » (p = 0029, β = −0,323, R2 = 9,4 %). Discussion Malgre les limites de notre enquete, les resultats ont permis de mettre en avant le lien entre empathie, le bien-etre professionnel et les traits de la personnalite relatifs a l’extraversion et l’agreabilite chez le medecin de famille. Ce qui est concordant avec certaines etudes. Conclusion Notre travail a permis de mettre en evidence les determinants de l’empathie. Le bien-etre du medecin lui permet une meilleure communication mais egalement une meilleure ecoute et une meilleure empathie. Reste a developper par la suite les differentes methodes et techniques pouvant ameliorer l’empathie en fonction de la personnalite du medecin.

Nowadays, the huge number of smart connected objects and the massive data amount produced require intelligent approaches for their management and supervision. Accordingly, Software Defined Networking (SDN) is considered as a promising paradigm for Internet of things (IoT) management. The IoT is now involved deeply in our daily activities and influences considerably our life style; from the way we drive, to how we make purchases or even what we should eat or not to maintain our health etc. The diversity of IoT related applications necessitates flexible, agile and adaptable IoT architecture. To meet this requirement, the design of IoT architecture based on SDN involves decoupling control plane from data plane to integrating intelligent management functionalities. In this context, this survey highlights the IoT network management functionalities and studies the correlation between SDN and IoT with focuses the role played by SDN to improve the management effectiveness of IoT networks. Furthermore, deep investigation is elaborated related to the SDN-IoT architectures and applications and some open issues and future research directions are provided.

One of the key goals of future 5G networks is to incorporate many different services into a single physical network, where each service has its logical network isolated from other networks. Besides, Network Slicing (NS) is considered as the key technology for meeting the service requirements of diverse application domains. Recently, NS faces several algorithmic challenges for 5G networks. This paper provides a review related to NS architecture with a focus on relevant Management and Orchestration (MANO) architecture across multiple domains. In addition, this survey paper delivers a deep analysis and a taxonomy of NS algorithmic aspects. Finally, this paper highlights some of the open issues and future directions.

Lateral opening wedge distal femoral osteotomy (LOWDFO) is indicated for isolated lateral osteoarthritis in the valgus morphotype. Medial hinge fracture is a factor for poor prognosis. The present study had two aims: 1) to assess the impact of a temporary K-wire on hinge fracture risk; and 2) to assess the impact of LOWDFO opening speed.The main study hypothesis was that a temporary hinge K-wire reduces hinge fracture risk. The second hypothesis was that faster opening speed increases fracture risk.Twenty femurs were produced by 3D printing from a CT database, reproducing LOWDFO anatomy. The ABS® polymer showed the same breaking-point behavior as human bone. Ten specimens were included in the "K-wire" group (KW+) and 10 in the "No K-wire" group (KW-). To determine high and low speed, a motion-capture glove was used by 2 operators, providing 3D modeling of the surgeon's hand. High speed was defined as 152mm/min and low speed as 38mm/min. The KW+ and KW- groups were subdivided into high- and low-speed subgroups (HS, LS) of 5 each. Compression tests were conducted using an Instron® mechanical test machine up to hinge fracture. The main endpoint was maximum breaking-point force (N); the secondary endpoints were maximum displacement (mm) and maximum speed (min) at breaking point.The K-wire significantly increased maximum breaking-point force (LS, 143.08N vs. 93.71N, p0.01; and HS, 186.98N vs. 95.22N, p0.01), but not maximum displacement (LS, 26.17mm vs 24.11mm, p= 0.31; and HS 26.18mm vs. 23.66mm, p=0.14) or maximum time (LS, 27.07sec vs. 24.94sec, p=0.31; and HS, 5.24sec vs. 4.73sec, p=0.14). Speed did not affect maximum force (KW+, 143.08N vs. 186.98N, p= 0.06; and KW-, 93.71N vs. 95.22N, p=0.42) or maximum displacement (KW+, 26.17mm vs. 26.18mm, p=1; and KW-, 24.11mm vs. 23.66mm, p=0.69). Only maximum time was greater at low speed (KW+, 27.07sec vs. 5.24sec, p0.01; and KW-, 24.94sec vs. 4.73sec, p0.01), which is obvious for constant distance.The first study hypothesis was confirmed, with significantly lower hinge fracture risk with the K-wire, independently of opening speed. The second hypothesis was not confirmed. The study was performed under strict experimental conditions, unprecedented to our knowledge in the literature. However, complementary clinical studies are needed to confirm the present findings.IV, experimental study.

Valgus-producing medial opening-wedge proximal tibial osteotomies (V-MOW-PTO) are used to treat isolated medial-compartment knee osteoarthritis in patients with varus malalignment. A fracture of the lateral cortical hinge is a risk factor for poor outcomes. Implantation of a protective K-wire has been suggested to prevent this complication. The primary objective of this bench study was to assess the ability of a protective K-wire to prevent lateral cortical fractures. The secondary objective was to evaluate the influence of the opening speed on fracture risk during the osteotomy.The primary hypothesis was that a protective K-wire decreased the risk of hinge fracture. The secondary hypothesis was that this risk was greater when the opening speed was high.We performed an experimental study of 20 simulated thermoplastic-polymer (ABS) tibias obtained by 3D printing to assess the effects of wedge-opening speed (high vs. low) and presence of a protective K-wire (yes vs. no). The opening rates were determined in a preliminary study of Sawbone® specimens opened using a distractor. The opening rate was measured using an accelerometer via a motion-capture glove. After assessing several high and low opening speeds, we selected 38mm/min and 152mm/min for the study. We divided the 20 ABS specimens into four groups of five each: high speed and K-wire, low speed and K-wire, high speed and no K-wire, and low speed and no K-wire. The force was applied using an Instron™ testing machine until construct failure. The primary outcome measure was the load at failure (N) and the secondary outcome measures were the displacement (mm) and maximum time to failure (s).At both speeds, values were significantly higher with vs. without a K-wire for load to failure (low: 253.3N vs. 175.5N, p0.01; high: 262.2N vs. 154.1N, p0.01), displacement (low: 11.1mm vs. 8.7mm, p0.01; high: 11mm vs. 8.9mm; p=0.012), and maximal time to failure (low: 11.4 s vs. 8.9 s; p=0.012; high: 2.2 s vs. 1.8 s; p=0.011). Thus, the osteotomy opening speed seemed to have no influence on the risk of lateral cortex fracture.Our main hypothesis was confirmed but our secondary hypothesis was refuted: a protective K-wire significantly decreased the risk of hinge fracture, whereas the osteotomy opening speed had no influence. To our knowledge, this is the first published study assessing the potential influence of opening speed on risk of lateral cortex fracture. Our findings were obtained in the laboratory and should be evaluated in clinical practice.IV, experimental study.

The aim of the present in vitro study was to evaluate specific mechanical and physicochemical properties of two calcium silicate based sealers, (AH Plus Bioceramic “AHPB”; Well-Root ST “WRST”), and a conventional resin sealer (AH Plus “AHP”). These aims were accomplished by assessing the porosity, pH, compression strength, roughness, wettability and cell attachment of the tested materials. The results were compared statistically using the one-way ANOVA test. Higher pH values were obtained in both AHPB and WRST compared to AHP at 3, 24 and 72 h (p < 0.05). A greater level of porosity and wettability was detected for both AHPB and WRST compared to the resin sealer AHP (p < 0.05). Evident cell growth characterized by elongated morphology was observed on the surface of AHPB and WRST, while only a thin layer of cells was seen on the surface of AHP. A significant lower compression strength and modulus were obtained in the specimens created using AHPB compared to those made with AHP and WRST (p < 0.05). The removal of calcium silicates may be quite tricky during endodontic retreatment. In conclusion, considering the limitations of the present in vitro study, both calcium silicate sealers demonstrated good physicochemical properties. However, the lower compression strength and modulus of AHPB may facilitate its removal and make the retreatment procedures considerably easier. Keywords: calcium silicate based sealer; resin sealer; mechanical properties; porosity

Wireless Sensor Networks (WSNs) are prone to highly constrained resources, as a result ensuring the proper functioning of the network is a requirement. Therefore, an effective WSN management system has to be integrated for the network efficiency. Our objective is to model, design, and propose a homogeneous WSN hybrid architecture. This work features a dedicated power utilization optimization strategy specifically for WSNs application. It is entitled Hybrid Energy-Efficient Power manager Scheduling (HEEPS). The pillars of this strategy are based on the one hand on time-out Dynamic Power Management (DPM) Intertask and on the other hand on Dynamic Voltage and Frequency Scaling (DVFS). All tasks are scheduled under Global Earliest Deadline First (GEDF) with new scheduling tests to overcome the Dhall effect. To minimize the energy consumption, the HEEPS predicts, defines and models the behavior adapted to each sensor node, as well as the associated energy management mechanism. HEEPS’s performance evaluation and analysis are performed using the STORM simulator. A comparison to the results obtained with the various state of the art approaches is presented. Results show that the power manager proposed effectively schedules tasks to use dynamically the available energy estimated gain up to 50%.