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The translocon-associated protein (TRAP) complex resides in the endoplasmic reticulum (ER) membrane and interacts with the Sec translocon and the ribosome to facilitate biogenesis of secretory and membrane proteins. TRAP plays a key role in the secretion of many hormones, including insulin. Here we reveal the molecular architecture of the mammalian TRAP complex and how it engages the translating ribosome associated with Sec61 translocon on the ER membrane. The TRAP complex is anchored to the ribosome via a long tether and its position is further stabilized by a finger-like loop. This positions a cradle-like lumenal domain of TRAP below the translocon for interactions with translocated nascent chains. Our structure-guided TRAP mutations in Caenorhabditis elegans lead to growth deficits associated with increased ER stress and defects in protein hormone secretion. These findings elucidate the molecular basis of the TRAP complex in the biogenesis and translocation of proteins at the ER., Nature Structural & Molecular Biology, 30 (6), ISSN:1545-9993, ISSN:1545-9985

Our understanding of protein synthesis has been conceptualised around the structure and function of the bacterial ribosome. This complex macromolecular machine is the target of important antimicrobial drugs, an integral line of defence against infectious diseases. Here, we describe how open access to cryo-electron microscopy facilities combined with bespoke user support enabled structural determination of the translating ribosome from Escherichia coli at 1.55 Å resolution. The obtained structures allow for direct determination of the rRNA sequence to identify ribosome polymorphism sites in the E. coli strain used in this study and enable interpretation of the ribosomal active and peripheral sites at unprecedented resolution. This includes scarcely populated chimeric hybrid states of the ribosome engaged in several tRNA translocation steps resolved at ~2 Å resolution. The current map not only improves our understanding of protein synthesis but also allows for more precise structure-based drug design of antibiotics to tackle rising bacterial resistance.

Introduction Chronic stress can interrupt personal life and cause fatigue, inability to concentrate, and irritability. This study aims to determine the prevalence of stress and its associated factors among medical students in Syria and whether social support could be a protective factor against stress. Methods A cross-sectional study was conducted in the faculty of medicine of five Syrian universities. The Medical Student Stressor Questionnaire (MSSQ) was used to evaluate the stress caused by the possible sources of stress. And Social Support Questionnaire – short version (SSQ – short version) was used to assess the social support that medical students received from family, friends, and their fellow medical students using six questions. Results A total of 1472 medical students participated in the study. Among the total participants, 671 (45.6%) were males, and 801 (54.4%) were females. The majority of the participators had mild (50.6%; n = 745) and moderate (37.0%; n = 545) stress levels. Academic-related stressors were the most important cause of stress among undergraduate medical students. Social support was provided equally to both genders, and genders reported the same degree of satisfaction. Conclusion Our results emphasize the importance of improving the curricula, providing mental health consultants for students, and paying more attention to the mental health of female students. Finally, students in their clinical years should also receive mental health care, decreasing their duties and providing more self-free time.

Background Pain is a common complaint among hemodialysis patients. End-stage renal disease patients are at high risk of vitamin D deficiency and poor Quality of life (QoL). This study aims to find the prevalence of chronic pain and its correlation with QoL and vitamin D level among hemodialysis patients in Palestine. Methods This cross-sectional study was conducted between October 2021 to February 2022 at the hemodialysis unit of An-Najah National University Hospital, Palestine. We used the brief pain inventory, the medical outcomes study 36-item short-form health survey, and Serum 25-hydroxyvitamin D to assess chronic pain, QoL, and vitamin D deficiency. A multiple linear regression analysis models determined the correlation between the QoL scores and other independent variables. Results The study included 200 patients, 38.1% (95% CI: 31.3–45.4%) of whom had chronic pain and 77.7% (95% CI: 71.0-83.4%) had deficient Vitamin D levels. QoL scores were generally low, with the highest score in social functioning, followed by mental health, while the lowest was found in role emotional and physical functioning. Sex, number of comorbidities, and vitamin D level are significantly correlated with pain severity. Employment, numbers of comorbidities, pain severity, and albumin level are significantly associated with the Physical component of QoL. On the other hand, employment and pain severity are significantly related to the mental component of QoL. Conclusions Low vitamin D levels, chronic pain, and low QoL scores are common among hemodialysis patients. Vitamin D is negatively correlated with pain severity. Unemployment, comorbidities, severe pain, and low level of albumin are associated with reduced QoL scores. Healthcare workers should assess and manage HD patients' chronic pain to improve their QoL and reduce suffering.

To determine the intake levels, dietary sources, and determinants of free sugars (FS) consumption amongst Lebanese children and adolescents. This study is based on data collected by two national cross-sectional surveys conducted on representative samples of Lebanese children: survey 1 (under-five years (U5) children) (n = 899) and survey 2 (5–18 years-old children) (n = 1133). Multi-component questionnaires were used for data collection. Dietary intakes were assessed using one 24 h dietary recall. Median daily intakes of FS, and percent contribution of various food groups to FS intake were compared between sex and age groups. Logistic regressions were conducted to explore the determinants of high FS intake (> 10% energy intake/d), as per the WHO recommendations. Median contribution of FS to daily energy intake was 8.5% in U5 children and 11.9% amongst those aged 5–18 years old. The top contributors to FS in both surveys were sugar-sweetened beverages and biscuits and chocolates. The proportion of children and adolescents exceeding WHO upper limits for FS was estimated at 43 and 62% in survey 1 and survey 2, respectively. Regression models showed females, higher household monthly incomes and higher parental educational levels were associated with significantly lower odds of exceeding the WHO upper limit for FS. The study showed that a high proportion of Lebanese children and adolescents exceeded the WHO upper limit for FS intake, while also documenting a socioeconomic gradient in FS intake. Findings call for devising food system-based interventions to help reduce FS intake in this nutritionally vulnerable age group.

Given the increase of Tunisia's car fleet and the high utilization of tires, waste production has risen sharply, causing enormous economic and environmental problems in this country. Our research team is in the process of developing different axes of valorization of this waste tires crumbs from the perspective of the field of civil engineering. This work presents the first results of the valorization in the road surface by producing a bituminous concrete (BC) containing aggregates coming from waste tires (crumbs). This study is carried out using the aggregates of DJebel El Oust showing that the addition of the rubber crumb reduces the mechanical strength, and on the other hand, the compactness increases and the resistance to water is improved. An environmental study was conducted on the modified bituminous concrete mixed with waste tires crumbs. It is recommended that in order to reduce the environmental impacts, the modified bituminous concrete is best used on acid Tunisian soils located mainly in the extreme North West region of the country.

BackgroundThis is the first study on dietary intakes of infants and young children in the Eastern Mediterranean Region, a region that is currently witnessing the nutrition transition. It aims at characterizing food consumption patterns amongst 0–4 year old children in Lebanon, evaluating their macro- and micronutrient intakes and assessing adherence to dietary recommendations.MethodsBased on a national cross-sectional survey in 2012 (n = 866), the study collected data on sociodemographic and anthropometric characteristics, and one 24-hour dietary recall was administered. Nutrient intakes were compared with reference values: Estimated Average Requirement (EAR), Adequate Intake (AI) and Acceptable Macronutrient Distribution Range (AMDR).ResultsMilk was the highest contributor to energy intake (EI) in infants (95.8 and 56.5% in 0–5.9 months and 6–11.9 months old infants, respectively), while its intake was lower among toddlers and preschoolers (35.4 and 15.1%, respectively). In contrast, intakes of sweets and sweetened beverages were the highest in preschoolers compared to younger children, contributing 18.5% EI in preschoolers. Compared to dietary guidelines, the lowest dietary adherence was found for vegetables (17.8–20.7%) and fruits (14.4–34.3%). Protein intake was within the recommendations for the vast majority of children. Although total fat intake was lower in toddlers and preschoolers compared to infants, more than 40% of toddlers and preschoolers exceeded the AMDR for fat and 87.3% of preschoolers exceeded the upper limit for saturated fat. Only 3.6% of toddlers and 11.5% of preschoolers exceeded the AI level for dietary fiber. Micronutrient intake assessment showed that mean intakes in infants exceeded the AI for all micronutrients, except for vitamin D and magnesium. In toddlers, vitamin D and calcium were below the EAR among 84.7, and 44.6%, respectively. In preschoolers, most of the children (91.9%) had inadequate intakes of vitamin D, and a third had inadequate intakes of folate, calcium and vitamin A.ConclusionsThis study identified priority issues for nutrition intervention in infants and young children in Lebanon. Concerted multi-stakeholder efforts are needed to instill heathier food consumption and nutrient intake patterns early in life.

Background Ischemic strokes are common neurological disease and unless being managed fast enough within hours of onset a permanent deficit usually results. Such deficit impairs the patient independency to a great extent. Aphasia affects more than a quarter of acute stroke cases. Initially it is more prominent and with time its severity may subside, yet to which degree and what factors play a role in this severity reduction still needs further studies and is under postulations. Case presentation Multilingual role in post-stroke aphasia recovery is presented in this case report where a trilingual female who acquired a foreign accent and who involuntarily uses code switching between Arabic, French and English in order to linguistically communicate; thus overcoming post-stroke language communication problems. The neurolinguistics data are taken from the results of the application of the Western Aphasia Battery-Revised scale in Cairene Dialect, in addition to extra language exercises including repetition, picture description and conversation with the patient. Linguistic analysis includes the investigation of morph syntactic constructions, phonetic deviations and semantic paraphasia. Linguistic analysis also revealed that the patient’s aphasia disorder is of the conduction type and that she resorts to her second language (L2) namely French or her third language (L3) namely English if she finds it difficult to produce the Arabic word. Conclusion Cognitive reserve and multilingualism may have a role in post-stroke aphasia recovery.

To derive dietary patterns (DPs) of Lebanese adolescents (10–18 years) and evaluate associations between identified DPs and household food insecurity (HFI). Data on adolescents (n = 693) were drawn from a national survey conducted in 2015 on a representative sample of Lebanese households with children. In addition to a sociodemographic questionnaire, data collection included the validated Arabic-version of the Household Food Insecurity Access Scale, used to evaluate HFI. Dietary intake was assessed using a 187-item validated food frequency questionnaire. Associations between HFI scores and DPs were examined using multiple linear regressions. HFI was observed in 55.2% of the study sample. Two DPs were derived among adolescents: Western and Lebanese-Mediterranean (LM). The Western DP was characterized by higher consumption of sweetened beverages, fast foods, sweets, and refined grains, whereas the LM DP was characterized by higher intakes of fruits, vegetables, dairy products, and whole grains. Scores of the Western DP were negatively associated with fiber, calcium, iron, and vitamins A and D, while the LM DP scores were positively correlated with fiber, proteins, iron, calcium, and vitamins A and D (p

Hard turning technology was proven effective in enhancing the surface finish and dimensional accuracy of hardened steel. For this reason, it is used for finishing operations in the manufacturing of some critical aircraft landing gear components where bulk material hardness exceeds 45 HRC such as 300M ultra-high-strength steel. Nonetheless, the selection of cutting conditions remains critical to ensure generated surface characteristics meet the performance requirements. In this context, this study focuses on the optimization of hard turning cutting conditions to reduce surface roughness, increase compressive surface residual stresses, and reduce surface white layer thickness of 300M ultra-high-strength steel (55 HRC). To this end, a design of experiments (DoE) is used to investigate the effects of cutting tool (T), cutting speed (V), feed rate (f), and depth of cut (D) during hard turning. The cutting tool materials investigated include physical vapor deposited AlTiN–coated cemented carbide, mixed ceramic, and polycrystalline cubic boron nitride (PCBN), all commonly used in hard turning. Three different optimization approaches are evaluated and compared, namely the single-response Taguchi method, the multi-response grey relational analysis (GRA), and the proportion quality loss reduction (PQLR) methodologies. Because responses were found to be correlated, the selected multi-response optimization approaches were combined with the principal component analysis (PCA) method to transform correlated parameters into uncorrelated ones. The effect of cutting parameters and their interactions on surface roughness (Ra) and white layer thickness (WL) were considered in detail, particularly the effect of cutting tool material. Results demonstrate that the PCA-based GRA approach is a very suitable optimization technique for hard turning of 300M steel. Under those optimized conditions, Ra was decreased by 50%, and WL was decreased by 6% while compressive axial surface residual stress (ASRS) and hoop surface residual stress (HSRS) were increased by 307% and 74%, respectively.

An original approach is introduced to discriminate the effects of residual stress and surface roughness on turned Inconel 718 alloy parts. This could be used for assessing or studying the performance of these specimens during fatigue tests. This method consists of building surface integrity maps in terms of surface roughness parameters and residual stress in order to select specific turning conditions with adequate machining parameters. The surface integrity maps were generated by using response surface methodology based empirical models and precision turning tests on coupons. The proposed approach was therefore successfully applied to manufacture rotating bending fatigue specimens with the surface axial residual stress varying from − 239 to 446 MPa while keeping the arithmetic average roughness and the surface hoop residual stress constant. The effect of the surface axial residual stress on the fatigue life could thus be discriminated from the other surface integrity characteristics effects. The proposed methodology is independent of the manufacturing process and can be extended to other machining processes such as milling, grinding, and broaching.

A laboratory investigation has been achieved to study the effect of flow velocity on the corrosion behaviour of Cu–Ni 90/10 alloy immersed in synthetic seawater, at 60 °C which simulates the real condition of desalination industry in the south of Tunisia. Flow velocity was one of major parameters influencing the oxidation process of cupronickel pipe, through its effect on mass transport and corrosion rate. This influence has been examined on a laboratory scale by means of electrochemical techniques like: Potentio-dynamic polarization, electrochemical impedance spectroscopy (EIS) and linear polarization resistance (LPR). Results show that the flow velocity has a significant influence on corrosion rate, compared to static immersion. This effect was confirmed by means of corrosion current density (icorr) increase and polarization resistance Rp decrease with exposure time, as indicated by LPR and EIS measurements. Corrosion was attributed to the film deterioration by the erosion corrosion phenomena, caused essentially by hydrodynamic conditions. Indeed, at stagnant condition, the substrate proves a higher corrosion resistance due to the stability of the protective layer.

Background Syrian healthcare workers (HCWs) are among those who fled the Syrian conflict only to face further social and economic challenges in host countries. In Lebanon, this population group cannot formally practice, yet many are believed to be operating informally. These activities remain poorly documented and misunderstood by the academic, policy and humanitarian communities. This study aims to understand mechanisms of informal provision of services, the facilitators and barriers for such practices and to present policy recommendations for building on this adaptive mechanism. Method A qualitative descriptive study based on an in-depth interview approach with a sample of Syrian informal healthcare workers (IHCWs) residing in Lebanon was adopted. Known sponsor networks followed by snowball sampling approaches were used to recruit participants. Data collection occurred between September and December 2017. All interviews were audio-recorded, transcribed and translated into English. An inductive thematic analysis was used. Results Twenty-two participants were recruited. Motivational factors that led HCWs to practice informally were personal (e.g. source of income/livelihood), societal (cultural competency), and need to fulfill a gap in the formal health service sector. Being connected to a network of IHCWs facilitated initiation of the informal practice until eventually becoming part of a community of informal practice. The central challenge was the informal nature of their practice and its negative consequences. Most IHCWs were afraid of arrest by the government upon identification. Most interviewees indicated being discriminated against by host communities in the form of differential wages and tense interpersonal relationships. Almost all recommended a change in policy allowing them to practice formally under a temporary registration until their return to Syria. Conclusion Our study confirmed the presence of IHCWs operating in Lebanon. Despite its informal nature, participants perceived that this practice was filling a gap in the formal health system and was helping to alleviate the burden of IHCWs and refugee health needs. In line with interviewees’ views, we recommend that policy decision makers within humanitarian agencies and the Government of Lebanon explore the possibilities for allowing temporary registration of displaced Syrian IHCW to benefit local host communities and refugee populations. Electronic supplementary material The online version of this article (10.1186/s13031-019-0224-y) contains supplementary material, which is available to authorized users.

Finite Element (FE) modeling of machining processes has received growing attention over the last two decades. Since machining processes operate at severe deformation conditions, involving very high strain, strain rate, stress, and temperature, the modeling procedure is still a challenging task even with new advanced software and computers. Therefore, most of the published research works were mainly performed for the simplest configuration of machining known as orthogonal cutting, in which a plane strain deformation state is assumed. This configuration leads to reducing the number of elements in the FE model and the computational time of the solution, compared to conventional machining processes (turning, milling, and drilling). Nevertheless, FE modeling of orthogonal turning is still considered as an open-ended subject as most of the phenomena involved in the orthogonal turning process, which also exist in other machining operations, are not fully well understood. The present review article deals with finite element modeling of orthogonal machining process. The paper consists of several related parts. First, the fundamentals of the FE simulation of orthogonal turning process are briefly described. Then, a detailed review on the FE prediction of machining characteristics including chip morphology, cutting forces, cutting temperature, tool wear, and burr formation is provided. Also, the FE prediction of surface integrity characteristics including residual stresses and microstructural changes is discussed. The influence of input model and parameters including thermal, material, and frictional models as well as size and arrangement of elements on machining and surface integrity characteristics are explained as well. Both technical and statistical aspects of the FE simulation of orthogonal turning are treated. Since there is no review paper thoroughly and specifically discussing the methods and findings of the finite element simulation of turning operations, the present article can be used as a reference for researchers who are active and/or interested in this filed.

Purpose The high burden of preschool overweight in the Middle East and North Africa highlights the need for rigorous investigations of its determinants. This study aims at identifying dietary patterns amongst preschoolers in Lebanon and assessing their association with overweight and obesity. Methods A national cross-sectional survey was conducted amongst 2–5-year-old children (n = 525). Socio-demographic, dietary, lifestyle and anthropometric variables were collected. Dietary patterns were derived by factor analysis. Overweight/obesity was defined based on the World Health Organization 2006 criteria (BMI-for-age z-score > + 2). Results Two patterns, “Fast Food and Sweets” and “Traditional Lebanese”, were identified. The “Fast Food and Sweets” pattern was characterized by higher consumption of sweetened beverages, fast foods, salty snacks and sweets. The “Traditional Lebanese” was driven by higher intakes of cereals, dairy products, fruits and vegetables. Children belonging to the 3rd tertile of the Traditional pattern scores had significantly lower odds of overweight/obesity compared to the 1st tertile (OR 0.33; 95% CI 0.11, 0.97). Higher maternal education and higher frequency of eating with family predicted adherence to the traditional pattern, while the presence of a household helper was a negative determinant. Adherence to the Fast Food and Sweets pattern was positively associated with the child’s age, and negatively associated with female gender and maternal education. Conclusions The “Traditional Lebanese” pattern was associated with decreased risk of preschool overweight. Policies aiming at re-anchoring this traditional dietary pattern in contemporary lifestyles may be developed as potential preventive strategies against overweight in this age group.

Seven new platinum(II) complexes (1-7) of triethylphosphine (Et3P) and thiones (L) with general formula, cis-[Pt(Et3P)2(L)2]Cl2 were prepared and characterized by elemental analysis, FTIR and NMR (1H, 13C & 31P) measurements. The analytical and spectroscopic data suggested the formation of the desired complexes. The complexes were tested for in vitro cytotoxicity against four cell lines: Hela (human cervical adenocarcinoma), MCF-7 (human breast carcinoma), A549 (human lung carcinoma), and HTC15 (human colon carcinoma). The anticancer activity values of compounds 1-6 are much better than cisplatin and carboplatin as indicated by their IC50 values.

300M steel is commonly used in the automotive and aerospace industries due to its high strength and fatigue life. Residual stresses induced by machining of these materials can greatly affect the fatigue life. The present research aims mainly to develop an optimization strategy to identify optimal cutting parameters to improve machining characteristics and residual stresses induced by radial orthogonal turning 300M steel. To achieve this, first, a predictive finite element tool is developed to model cutting temperature, cutting and thrust forces, and residual stresses. Orthogonal turning experiment is conducted to measure machining forces, chip thickness, and residual stresses to validate the developed finite element model. The validated model is then used to construct response functions (meta models) using combined design of experiment and response surface method for practical and efficient implementation of the optimization problem. Finally, the developed response functions are utilized to formulate various multi-objective optimization problems. A hybrid optimization algorithm combining genetic algorithm and sequential quadratic programming method is employed to solve optimization problems in order to identify optimal cutting conditions and tool geometry. The results show that for unconstrained optimization problems, the percentage improvement in the total objective function is greater than that of constraint optimization ones. For multi-objective optimizations, it is found that weighting factors affect the optimum values of the total objective function more than those of the machining parameters. Since very few efforts were exerted to perform finite element modeling, experimental tests, and multi-performance optimization of machining characteristics and residual stresses induced by orthogonal turning 300M steel, the present results can be utilized as a reference for future works along this filed.

The machining of nickel-based superalloys used for aeronautical applications generates damage, deformation, and carbide cracking in machined surface and subsurface layers as a result of microstructural heterogeneities which reduce the fatigue life of aeronautic machined components. In this study, Inconel 718 was hard turned with a carbide tool using different cutting conditions according to a Roquemore 311B hybrid design of experiments (DOE) method. The main objective of the study was to model the effect of cutting parameters on the evolution of the microstructure and to accurately predict the alterations induced by machining, especially the deformed layer thickness (DL) and the average number of cracked carbides (ACC). The material removal rate (MRR) and the deformation power (E) were calculated in order to obtain a strong correlation between controlled cutting parameters and microstructure alterations. Damages were quantified using a confocal laser-digital microscope and were validated with the proposed models. These models showed a direct relation between both MRR and E with DL and ACC, with good prediction at a 95% confidence interval (CI).

Background This article systematically reviews the current evidence regarding inflammation in Tendinopathy with the aim to increase understanding of a potential common pathophysiology. Methods Following the PRISMA statements, the terms: (tendinopathy OR (tendons AND rupture)) AND (inflammation OR (inflammation AND cells) OR immune system OR inflammation mediators OR bacteria) were used. One thousand four hundred thirty-one articles were identified which was screened down to 53. Results 39/53 studies mentioned inflammatory cells but had contradicting conclusions. Macrophages were the most common cell type and inflammatory markers were detectable in all the articles which measure them. Conclusions The included studies show different conclusions, but this heterogeneity is not unexpected since the clinical criteria of ‘tendinopathy’ encompass a huge clinical spectrum. Different ‘tendinopathy’ conditions may have different pathophysiology, and even the same clinical condition may be at different disease stages during sampling, which can alter the histological and biochemical picture. Control specimen sampling was suboptimal since the healthy areas of the pathological-tendon may actually be sub-clinically diseased, as could the contralateral tendon in the same subject. Detection of inflammatory cells is most sensitive using immunohistochemistry targeting the cluster of differentiation markers, especially when compared to the conventional haematoxylin and eosin staining methods. The identified inflammatory cell types favour a chronic inflammatory process; which suggests a persistent stimulus. This means NSAID and glucocorticoids may be useful since they suppress inflammation, but it is noted that they may hinder tendon healing and cause long term problems. This systematic review demonstrates a diversity of data and conclusions in regard to inflammation as part of the pathogenesis of Tendinopathy, ranging from ongoing or chronic inflammation to non-inflammatory degeneration and chronic infection. Whilst various inflammatory markers are present in two thirds of the reviewed articles, the heterogenicity of data and lack of comparable studies means we cannot conclude a common pathophysiology from this systematic review.

Syrian healthcare workers (HCWs) are among those who fled the Syrian conflict only to face further social and economic challenges in host countries. In Lebanon, this population group cannot formally practice, yet many are believed to be operating informally. These activities remain poorly documented and misunderstood by the academic, policy and humanitarian communities. This study aims to understand mechanisms of informal provision of services, the facilitators and barriers for such practices and to present policy recommendations for building on this adaptive mechanism.A qualitative descriptive study based on an in-depth interview approach with a sample of Syrian informal healthcare workers (IHCWs) residing in Lebanon was adopted. Known sponsor networks followed by snowball sampling approaches were used to recruit participants. Data collection occurred between September and December 2017. All interviews were audio-recorded, transcribed and translated into English. An inductive thematic analysis was used.Twenty-two participants were recruited. Motivational factors that led HCWs to practice informally were personal (e.g. source of income/livelihood), societal (cultural competency), and need to fulfill a gap in the formal health service sector. Being connected to a network of IHCWs facilitated initiation of the informal practice until eventually becoming part of a community of informal practice. The central challenge was the informal nature of their practice and its negative consequences. Most IHCWs were afraid of arrest by the government upon identification. Most interviewees indicated being discriminated against by host communities in the form of differential wages and tense interpersonal relationships. Almost all recommended a change in policy allowing them to practice formally under a temporary registration until their return to Syria.Our study confirmed the presence of IHCWs operating in Lebanon. Despite its informal nature, participants perceived that this practice was filling a gap in the formal health system and was helping to alleviate the burden of IHCWs and refugee health needs. In line with interviewees' views, we recommend that policy decision makers within humanitarian agencies and the Government of Lebanon explore the possibilities for allowing temporary registration of displaced Syrian IHCW to benefit local host communities and refugee populations.