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The Hebrew phrase śôm śekel which occurs in the narrative of the reading of the Law in Neh. 8:8 is usually understood literally as 'setting or giving (śôm) sense (śekel)’, based on the context of the verse. This article suggests that the phrase śôm śekel is an idiom meaning ‘to give an order, to instruct’, a calque translation from Aramaic śîm ṭĕʿēm and Akkadian ṭēma šakānu. While the Hebrew noun śekel is the semantic equivalent of Akkadian ṭēmu and Aramaic ṭĕʿēm, all meaning ‘insight, understanding’ (especially in the books of Ezra, Nehemiah and Chronicles, where Hebrew ṭaʿam is not attested), the noun śekel in the phrase śôm śekel is a semantic loan, which extends the original meaning of the noun from the additional meaning of Akkadian ṭēmu, and Aramaic ṭĕʿēm (especially in the phrase śîm ṭĕʿēm), denoting ‘order, instruction, report’. [ABSTRACT FROM PUBLISHER]

In recent years, the possible association of changes in mortality from cardiovascular disease and myocardial infarction (MI) and deaths related to violence and the suicide rate has been repeatedly discussed. This study examined the relationship between cosmic physical changes (solar, geomagnetic and other space activity parameters) and changes in the total number of in-hospital and MI-related deaths and deaths from suicide to determine if a relationship exists between the distribution of total and MI-related deaths with suicide over time; some differences in the serotonergic mechanisms involved in the pathogenesis of MI and suicide were also taken into account. All suicides ( n=2359) registered in the State of Israel from 1981 to 1989 (108 months) were analysed and compared with the total number of deaths ( n=15601) and deaths from MI ( n=1573) in a large university hospital over 180 months (1974-1989). The following were the main features of the Results. (1) Monthly suicide rate was correlated with space proton flux ( r=0.42, P=0.0001) and with geomagnetic activity ( r=−0.22, P=0.03). (2) Total hospital and MI-related deaths were correlated with solar activity parameters ( r=0.35, P<0.001) and radiowave propagation ( r=0.52-0.44, P<0.001), an with proton flux ( r=−0.3 to −0.26, P<0.01). (3) Monthly suicide distribution over 108 months was correlated with MI ( r=−0.33, P=0.0005) and total hospital mortality ( r=−0.22, P=0.024). (4) Gender differences were prominent. We conclude that the monthly distributions of suicides and deaths from MI are adversely related to many environmental physical parameters and negatively correlated with each other. [ABSTRACT FROM AUTHOR]

Trends in the epidemiology of infections due to Shigella species over a period of 6 years (1986–1991) in Israel were studied by analysis of the results of 51,300 stool cultures, of which 2,987 yielded Shigella species. In a university hospital, the relative prevalence of Shigella sonnei in patients with shigellosis increased over the years from 60% in 1986 to 91% in 1991 (r = 0.93; P = .007); concomitantly, the prevalence of Shigella flexneri decreased from 29% to only 8% (r = −0.80; P < .05). In the community, the increase in prevalence of S. sonnei was more moderate and occurred only from 1989 to 1991. Since 1990, S. sonnei has been isolated from more hospitalized patients than has S. flexneri, in contrast to their rates of isolation in the past. The increase in prevalence of S. sonnei was most prominent among children, in whom it caused 94% of shigella infections in 1991. Shigella boydii and Shigella dysenteriae remained relatively rare, causing ∼5% and ∼ 1%, respectively, of the cases of shigella infection. Concomitantly, the antimicrobial resistance of S. sonnei has become significantly greater, and it is currently 2.7 and 1.6 times higher than that of S. flexneri to trimethoprim-sulfamethoxazole and ampicillin, respectively. We conclude that the relative frequency of S. sonnei is increasing, especially in hospitalized patients, and hypothesize that this may be related to its increasing antimicrobial resistance. These trends have clinical implications. [ABSTRACT FROM PUBLISHER]

The possible relationship between epidemics and extremes of solar activity has been discussed previously. The purpose of the present study was to verify whether differences in the levels of immunoglobulins (IgA, IgG, IgM) could be noted at the highest (July 1989) and lowest (September 1986) points of the last (21st) and present (22nd) 11-year solar cycle. The work was divided into a 1-month study (covering the month of minimal or maximal solar activity), a 3-month study (1 month before and after the month of minimal or maximal solar activity) and a 5-month study (2 months before and after the month of minimal or maximal solar activity). A trend of a drop-off for all three immunoglobulins was seen on the far side of the maximal point of the solar cycle. Statistical significance was achieved in the 5-month study for IgM ( P=0.04), and a strong trend was shown for IgG ( P=0.07). Differences between the sexes were also noted. [ABSTRACT FROM AUTHOR]

Background: According to the literature, there are sex allocation inequalities in liver transplantation (LT). Sex disparities in outcomes after LT have been debated. This study aimed to evaluate sex-specific outcomes after LT, specifically short-term mortality and long-term survival rates., Methods: A retrospective cohort of the entire LT series from to 2010-2019 in a single center in which the inclusion criteria were adults ≥18 YO age who underwent primary deceased donor LT. Mortality rate was evaluated within 30 days and 6 months. Survival rate was evaluated at 1,3 and 5 years of age., Results: A total of 240 primary and deceased donor LTs (153 men and 87 women) were included. Mean age 55.2Y men and 51.6Y women (p = 0.02). Hepatocellular carcinoma (HCC) was the direct indication in 32.7% of the men and only 17.4% of the women. The leading primary liver morbidities were viral hepatitis (B, C, and D) in 38.3% (N = 92) and nonalcoholic steatohepatitis (NASH) in 20.8% (N = 50) of patients. Thirty-day mortality was 14%, which was significantly higher in men (18%) than in women (8%). Survival rates after 5 years were 64.9% and 78.3%, respectively. Multivariate analysis through logistic regression that included age, direct indication, MELD, and primary liver morbidity revealed statistically significant female to male Odds-Ratio of 0.4 in 30 days, 6 m mortality and a statistically significant higher long-term survival., Conclusions: Our observations revealed better female outcomes, namely, lower short-term mortality and higher long-term survival. Given the consistency after stratification and given the multivariate analysis, this is unlikely to be attributable to confounders. Such findings suggesting consistently better female outcomes have not been previously reported; hence, multi center study is encouraged., Competing Interests: None., (© 2022 The Authors.)

Background: In 2005, Clalit Health Services (CHS), the largest health maintenance organization in Israel, initiated an intervention program aimed at reducing the prevalence rate of infantile anemia (IA). This study evaluated the progress made during the intervention (2005-2014) and its yield 5 years after it ended (2019)., Methods: The CHS database was retrospectively reviewed twice yearly from 2005 to 2014 for repetitive samples of children aged 9 to 18 months regarding the previous half-year interval, and a single sample in 2019. Data were collected on gender, ethnicity (Jewish/non-Jewish), socioeconomic class (SEC; low/intermediate/high), hemoglobin testing (yes/no), and hemoglobin level (if tested). Excluded were infants with documented or suspected hemoglobinopathy., Results: At study initiation, the rate of performance of hemoglobin testing was 54.7%, and the IA prevalence rate was 7.8%. The performance rate was lower in the Jewish than the non-Jewish subpopulation. The low-SEC subpopulation had a similar hemoglobin testing rate to the high-SEC subpopulation but double the IA prevalence rate. Overall, by the end of the intervention (2014), the performance rate increased to 87.5%, and the AI prevalence rate decreased to 3.4%. In 2019, there was little change in the performance rate from the end of the intervention (88%) and the IA prevalence was further reduced to 2.7%. The non-Jewish and low-SEC subpopulations showed the most improvement which was maintained and even bettered 5 years after the intervention ended., Conclusions: The 10-year IA intervention program introduced by CHS in 2005 led to a reduction in IA prevalence rate to about 3.5% in all sub-populations evaluated. By program end, the results in the weaker subpopulations, which had the highest prevalence of IA at baseline, were not inferior to those in the stronger subpopulations. We recommended to the Israel Ministry of Health to adopt the intervention countrywide, and we challenge other countries to consider similar interventions., (© 2022. The Author(s).)

Objectives: To evaluate the sex-specific effects of stimulants in children with attention-deficit/hyperactivity disorder (ADHD) on body mass index (BMI) z and height z trajectories., Study Design: A retrospective cohort study using the database of Israel Clalit Health Services was performed. Participants included 5- to 18-year-old insured patients with documentation of at least 2 consecutive prescriptions of stimulant drugs for ADHD. Participants were further compared with sex- and age-matched insured control patients without ADHD., Results: A total of 4561 (66% boys) participants with ADHD were included. Of these, 2151 (70% boys) had follow-up data for ≥2 years of treatment. A decline of ≥1 SD in height and BMI z score was observed in 10.1% and 13.2% of the cohort, respectively. During ≥2 years follow-up, boys had a greater decline in height z score (~0.2 SD) than girls (~0.06 SD). Boys' height z score continued to decline after 1 and ≥2 years, and girls' height z score declined after 1 year, and then stabilized. The trajectory of BMI z score of boys and girls was similar, showing a greater decline after 1 year, followed by an incline after ≥2 years. Younger age at stimulants initiation, better adherence, longer treatment duration, and lower socioeconomic status were correlated with a greater impact on growth attenuation. The non-ADHD group (n = 4561, 66% boys) had baseline height z score and BMI z score similar to those in children with ADHD before treatment initiation. Height z score and BMI z score were greater in children without ADHD compared with children with ADHD following 1 year of treatment (P < .001)., Conclusions: These findings highlight the importance of growth monitoring accompanied with dietary counseling in children with ADHD treated with stimulants., (Copyright © 2021. Published by Elsevier Inc.)

Background: Sudden Infant Death Syndrome (SIDS) mechanisms of death remains obscured. SIDS' Triple Risk Model assumed coexistence of individual subtle vulnerability, critical developmental period and stressors. Prone sleeping is a major risk factor but provide no clues regarding the mechanism of death. The leading assumed mechanisms of death are either an acute respiratory crisis or arrhythmias but neither one is supported with evidence, hence both are eventually speculations. Postmortem findings do exist but are inconclusive to identify the mechanism of death. WHAT DOES THE PROPOSED HYPOTHESIS BASED ON?: 1. The stressors (suggested by the triple risk model) share a unified compensatory physiological response of decrease in systemic vascular resistant (SVR) to facilitate a compensatory increase in cardiac output (CO). 2. The cardiovascular/cardiorespiratory control of the vulnerable infant during a critical developmental period may be impaired. 3. A severe decrease in SVR is associated with hyper-dynamic state, high output failure and distributive shock., The Hypothesis: Infant who is exposed to one or more stressors responds normally by decrease in SVR which increases CO. In normal circumstances once the needs are met both SVR and CO are stabilized on a new steady state. The incompetent cardiovascular control of the vulnerable infant fails to stabilize SVR which decreases in an uncontrolled manner. Accordingly CO increases above the needs to hyper-dynamic state, high output heart failure and hyper-dynamic shock., Conclusions: The proposed hypothesis provides an appropriate alternative to either respiratory crises or arrhythmia though both speculations cannot be entirely excluded., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Aims: To evaluate in-hospital mortality rate within 24 hours in internal medicine wards and to evaluate if it may be used as quality indicator., Background: In-hospital mortality rate is an outcome measure which apparently reflects quality of care. There are debates on whether it may be considered a quality indicator since it is difficult to compare different case-mixes between hospitals. Research on mortality within 24 hours had not been published., Methods: An historical prospective study was conducted including the entire internal wards admissions to the Rabin Medical Center between 1/7/14 and 30/6/15. We evaluated inhospital deaths and 7 days post discharge deaths. We focused on deaths within 24 hours, patients' characteristics, the primary diagnosis (which we assumed is the cause of death) and co-morbidity. The analysis includes descriptive statistics and mortality rates performed with SPSS version 22., Results: Overall, 25,414 patients were admitted to internal wards during the study period. There were 1,620 in-hospitals deaths (6.37%) among which 164 deaths occurred within 24 hours (0.65%), which is 10.1% of in-hospital deaths. These patients were very old (median 82), many were residents of nursing homes and nearly all were brought to the hospital by ambulance. The most frequent primary diagnoses were sepsis (24%), pneumonia (22%), metastatic cancer (10%) and acute neurologic event (5%)., Conclusions: The results exclude excessive inhospital mortality within 24 hours. The patients' characteristics enable researchers to assume that these deaths were expected and not preventable., Discussion: There is no excessive mortality within 24 hours, the deaths were expected and a seasonal modifying effect was evident. All this and the different case mix in between hospitals suggest that early in-hospital mortality seems inadequate as a quality measure.

Background: To estimate the cardiovascular reserve we formulated the Cardiovascular Reserve Index (CVRI) based on physiological measurements. The aim of this study was to evaluate the pattern of CVRI in haemorrhage-related haemodynamic deterioration in an animal model simulating combat injury., Methods: Data were collected retrospectively from a research database of swine exsanguination model in which serial physiological measurements were made under anesthesia in 12 swine of haemorrhagic injury and 5 controls. We calculated the approximated CVRI (CVRI A ). The course of haemodynamic deterioration was defined according to the cumulative blood loss until shock. The ability of heart rate (HR), mean arterial blood pressure (MABP), stroke volume (SV), cardiac output (CO) and systemic vascular resistance (SVR) and the CVRI A to predict haemodynamic deterioration was evaluated according to three criteria: strength of association with the course of haemodynamic deterioration (r 2  > 0.5); threshold for haemodynamic deterioration detection; and range at which the parameter remained consistently monotonous course of deterioration., Results: Three parameters met the first criterion for prediction of haemodynamic deterioration: HR (r 2  = 0.59), SV (r 2  = 0.57) and CVRI A (r 2  = 0.66). Results were negative for MABP (r 2  = 0.27), CO (r 2  = 0.33) and SVR (r 2  = 0.02). The detection threshold of the CVRI A was 200-300 ml blood loss whereas HR, SV and CO showed a delay in detection, MABP and CVRI exhibited a wide indicative range toward shock., Conclusions: The CVRI A met preset criteria of a potential predictor of haemorrhage-related haemodynamic deterioration. Prospective studies are required to evaluate use of the CVRI in combat medicine., Level of Evidence: Level III.

Background: Hyperglycemia, high blood pressure and hypercholesterolemia are risk factors for diabetic retinopathy and vision loss in diabetic patients., Objectives: To evaluate risk factors in patients treated for diabetic retinopathy in our hospital clinic and assess patients' awareness of the impact of glycemic control; and to compare the findings with those in patients followed in a community clinic., Methods: We performed a cross-sectional comparative study that included 178 consecutive patients with type 2 diabetes mellitus treated in the Retinal Vascular Service of Rabin Medical Center from 1 September to 31 December 2004, and 107 consecutive patients with type 2 diabetes mellitus examined in a community clinic during the same period. A questionnaire was completed; the main outcome measures were glycemic and risk factor control and their correlation with diabetic retinopathy and visual acuity., Results: Although only 43% of the patients had heard of HbA1c, 98% of them had undergone this analysis, with a mean level of 8.2% (SD 1.9) in the hospital patients and 7.7% (SD 1.6) in the community patients (P= 0.01, t-test). HbA1c was lower in hospital patients who were aware of the test. Correlations were found for visual acuity, diabetic retinopathy and laser treatment with HbA1c < or = 7%, cholesterol level < 200 mg/dl and blood pressure < 130/85 mmHg., Conclusions: Since our study and previous reports have shown that HbA1c level < or = 7%, serum cholesterol level < 200 mg/dl and blood pressure < 130/85 mmHg are associated with better preservation of vision in patients with type 2 diabetes mellitus, we propose that the ophthalmologist has a role in educating patients about glucose, lipid and blood pressure control as part of the treatment of diabetic retinopathy.