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يعتبر القطاع الصحي من أهم القطاعات وأكثرها فاعلية في كل دولة، والتخصيص الأمثل للموارد في هذا القطاع مهم لخفض ارتفاع تكلفة الرعاية الصحية، حيث يواجه صانعو القرارات في النظام الصحي وخاصةً في المستشفيات موارد محدودة واحتياجات غير محدودة . هدف هذا البحث الى تطوير أداء مركز المعالجة الكيميائية والشعاعية في مشفى تشرين الجامعي باللاذقية، وذلك باستخدام أسلوب برمجة الأهداف على البيانات الخاصة بعام 2019 المتعلقة بالموارد البشرية والمادية الطبية بمركز المعالجة الكيميائية والشعاعية، ومعالجتها ببرنامج Win QSB للحصول على أفضل توزيع لهذه الموارد. وقد توصل الباحث الى بناء نموذج برمجة أهداف خطي لتخصيص الموارد البشرية والمادية الطبية بمركز المعالجة الكيميائية والشعاعية بالشكل الأمثل، وتقديم مقترحات لتطوير العمل في هذا المركز، حيث تبين من تطبيق أسلوب برمجة الأهداف وجود زيادة غير مستغلة في بعض هذه الموارد(الأطباء الاختصاصيين7، الممرضات73، فيزيائيين2، فنيي أشعة 11، كراسي جلد4، غرف2، عيادات3، أجهزة ضغط4، سماعات3، أمبو1، فراشي هواء1)، والسرعة والمرونة في التعاطي مع أي تغير يطرأ على المعطيات بفضل نتائج تحليل الحساسية للنموذج.

[Background] There is a lack of empirical evidence on the level of cultural adaptation required for psychological interventions developed in Western, Educated, Industrialized, Rich, and Democratic (WEIRD) societies to be effective for the treatment of common mental disorders among culturally and ethnically diverse groups. This lack of evidence is partly due to insufficient documentation of cultural adaptation in psychological trials. Standardised documentation is needed in order to enhance empirical and meta-analytic evidence. [Process] A “Task force for cultural adaptation of mental health interventions for refugees” was established to harmonise and document the cultural adaptation process across several randomised controlled trials testing psychological interventions for mental health among refugee populations in Germany. Based on the collected experiences, a sub-group of the task force developed the reporting criteria presented in this paper. Thereafter, an online survey with international experts in cultural adaptation of psychological interventions was conducted, including two rounds of feedback. [Results] The consolidation process resulted in eleven reporting criteria to guide and document the process of cultural adaptation of psychological interventions in clinical trials. A template for documenting this process is provided. The eleven criteria are structured along A) Set-up; B) Formative research methods; C) Intervention adaptation; D) Measuring outcomes and implementation. [Conclusions] Reporting on cultural adaptation more consistently in future psychological trials will hopefully improve the quality of evidence and contribute to examining the effect of cultural adaptation on treatment efficacy, feasibility, and acceptability.

يقدم هذا البحث دراسة تجريبية-تحليلية لسلوك القص في الجوائز البيتونية المسلحة بإضافة ألياف الكربون إلى بيتون هذه الجوائز غير الحاوية على أساور عرضية لدراسة تأثيرها على مقاومة القص ، حيث تبين من الدراسة أن إضافة ألياف الكربون للخلطة البيتونية تحسن سلوك القص للجوائز البيتونية وتزيد من مقاومته، كما تؤدي إضافة ألياف الكربون إلى زيادة حمولة الانهيار بنسبة (10.8-32.3)% مقارنة مع حالة استخدام بيتون بدون ألياف كربون. تهدف الدراسة التحليلية إلى تطوير علاقة مقاومة القص للجوائز البيتونية المسلحة الحاوية على ألياف الكربون، وذلك بالاعتماد على نتائج الدراسة التجريبية للبحث ولأبحاث سابقة باستخدام التحليل الإحصائي، وقد تم التوصل إلى العلاقة التي تعبر بشكل جيد عن سلوك مثل هذه العناصر.

Abstract Background Immunity against pathogens evolved through complex mechanisms that only for sake of simplicity are defined as innate immunity and adaptive immunity. Indeed innate and adaptive immunity are strongly intertwined each other during evolution. The complexity is further increased by intrinsic mechanisms of immunity that rely on the action of intracellular molecules defined as restriction factors (RFs) that, particularly in virus infections, counteract the action of pathogen gene products acting at different steps of virus life cycle. Main body and conclusion Here we provide an overview on the nature and the mode of action of restriction factors involved in retrovirus infection, particularly Human T Leukemia/Lymphoma Virus 1 (HTLV-1) infection. As it has been extensively studied by our group, special emphasis is given to the involvement of the MHC class II transactivator CIITA discovered in our laboratory as regulator of adaptive immunity and subsequently as restriction factor against HIV-1 and HTLV-1, a unique example of dual function linking adaptive and intrinsic immunity during evolution. We describe the multiple molecular mechanisms through which CIITA exerts its restriction on retroviruses. Of relevance, we review the unprecedented findings pointing to a concerted action of several restriction factors such as CIITA, TRIM22 and TRIM19/PML in synergizing against retroviral replication. Finally, as CIITA profoundly affects HTLV-1 replication by interacting and inhibiting the function of HTLV-1 Tax-1 molecule, the major viral product associated to the virus oncogenicity, we also put forward the hypothesis of CIITA as counteractor of HTLV-1-mediated cancer initiation.

Abstract Background The Institute for Healthcare Improvement identifies medication reconciliation as the shared responsibility of nurses, pharmacists, and physicians, where each has a defined role. The study aims to assess the clinical impact of pharmacy-led medication reconciliation performed on day one of hospital admission to the internal medicine service. Methods This is a pilot prospective study conducted at two tertiary care teaching hospitals in Lebanon. Student pharmacists who were properly trained and closely supervised, collected the medication history, and pharmacists at the corresponding sites performed the reconciliation process. Interventions related to the unintended discrepancies were relayed to the medical team. The main outcome was the number of unintended discrepancies identified. The time needed for medication history, and the information sources used to complete the Best Possible Medication History were also assessed. The unintended discrepancies were classified by medication class and route of medication administration, by potential severity, and by proximal cause leading to the discrepancy. For the bivariate and multivariable analysis, the dependent variable was the incidence of unintended discrepancies. The “total number of unintended discrepancies” was dichotomized into yes (≥ 1 unintended discrepancy) or no (0 unintended discrepancies). Independent variables tested for their association with the dependent variable consisted of the following: gender, age, creatinine clearance, number of home medications, allergies, previous adverse drug reactions, and number of information sources used to obtain the BPMH. Results were assumed to be significant when p was

Carnobacterium maltaromaticum is a non-starter lactic acid bacterium (LAB) of interest in the dairy industry for biopreservation. This study investigated the interference competition network and the specialized metabolites biosynthetic gene clusters (BGCs) content in this LAB in order to explore the relationship between the antimicrobial properties and the genome content. Network analysis revealed that the potency of inhibition tended to increase when the inhibition spectrum broadened, but also that several strains exhibited a high potency and narrow spectrum of inhibition. The C. maltaromaticum strains with potent anti-L. monocytogenes were characterized by high potency and a wide intraspecific spectrum. Genome mining of 29 strains revealed the presence of 12 bacteriocin BGCs: four of class I and eight of class II, among which seven belong to class IIa and one to class IIc. Overall, eight bacteriocins and one nonribosomal peptide synthetase and polyketide synthase (NRPS-PKS) BGCs were newly described. The comparison of the antimicrobial properties resulting from the analysis of the network and the BGC genome content allowed us to delineate candidate BGCs responsible for anti-L. monocytogenes and anti-C. maltaromaticum activity. However, it also highlighted that genome analysis is not suitable in the current state of the databases for the prediction of genes involved in the antimicrobial activity of strains with a narrow anti-C. maltaromaticum activity.

Background: E-mental health interventions may help to bridge the mental health treatment gap. Evidence on their effectiveness is compelling in high-income countries. Not enough evidence has been generated on their use with communities affected by adversity in low- and middle-income countries. The World Health Organization (WHO), the National Mental Health Programme (NMMP) at Ministry of Public Health (MoPH) in Lebanon and other partners have adapted a WHO intervention called Step-by-Step for use with Lebanese and displaced people living in Lebanon. Step-by-Step is a minimally guided, internet-based intervention for adults with depression. In this study, a feasibility randomised controlled trial (RCT) and a qualitative process evaluation were conducted to explore the feasibility and the acceptability of the research methods, and the intervention, in preparation for two fully powered trials to assess the effectiveness and cost-effectiveness of Step-by-Step in Lebanon. Method: Participants were recruited through social media. Inclusion criteria were: being able to understand and speak Arabic or English; access to an internet connected device; aged over 18; living in Lebanon; scores above cut-off on the Patient Health Questionnaire and the WHO Disability Assessment Schedule 2.0. Participants were randomly assigned to the intervention or enhanced care as usual. They completed post-assessments eight weeks after baseline, and follow-up assessments another three months later. Primary outcomes were depression and level of functioning, secondary outcomes were anxiety, post-traumatic stress, and well-being. Qualitative interviews were conducted to evaluate the feasibility and acceptability of the research procedures and the intervention. Results: A total of N = 138 participants, including 33 Syrians, were recruited and randomised into two equal groups. The dropout rate was higher in the control group (73% post- and 82% follow-up assessment) than in the intervention group (63% post- and 72% follow-up assessment). The intervention was perceived as relevant, acceptable and beneficial to those who completed it. Suggestions were made to further adapt the content and to make the intervention more engaging. Statistical analyses were conducted despite the small sample size. Complete cases analysis showed a statistically significant symptom reduction in depression, anxiety, disability, and post-traumatic stress, and statistically significant improvement in well-being and functioning. Intention-to-treat analysis revealed non-significant effects. Conclusion: The research design, methods and procedures are feasible and acceptable in the context of Lebanon and can be applied in the RCTs. Preliminary findings suggest that Step-by-Step may be effective in reducing symptoms of depression and anxiety and improving functioning and well-being.

Hypertrophic cardiomyopathy (HCM) is a common inherited cardiomyopathy, with an estimated prevalence of 1 in 500 people. Despite overall favorable outcomes with modern treatment and early diagnosis of disease, adverse complications could occur during times of physiological stress like pregnancy. Complications of HCM include sudden cardiac death, heart failure, and arrhythmia. We report the case of a 32-year-old pregnant woman with obstructive HCM, presenting with recurrent episodes of ventricular arrhythmia despite medical therapy. This case exhibits how close monitoring and proper management during pregnancy according to the latest recommendations, resulted in a successful and uneventful delivery.

Background: Peginterferon beta-1a administered every 2 weeks via subcutaneous (SC) injection is approved to treat adult patients with relapsing-remitting multiple sclerosis (RRMS) and relapsing forms of multiple sclerosis (RMS). However, associated injection site reactions (ISRs) can lead to treatment discontinuation. Prior studies with interferon beta-1a reported a lower frequency of ISRs with intramuscular (IM) administration than with SC administration. IM administration of peginterferon beta-1a may therefore represent a useful alternative treatment option. Methods: A phase I, open-label, two-period crossover study randomized healthy volunteers to receive a single dose of peginterferon beta-1a 125 mcg administered IM followed by a single 125 mcg dose administered SC after a 28-day washout or vice versa. Blood samples were collected up to 504 h post dose to determine pharmacokinetic (PK) and pharmacodynamic (PD) profiles. The primary endpoint was assessment of bioequivalence based on maximum serum concentration (C max ) and area under the curve from time zero extrapolated to infinity (AUC inf ). Other PK parameters, as well as PD (serum neopterin) and safety profiles, were also evaluated. Results: The study enrolled 136 participants. Bioequivalence of IM and SC peginterferon beta-1a was established for both C max ([least squares (LS)] mean IM/SC ratio: 1.083 [90% confidence interval (CI), 0.975–1.203]) and AUC inf (LS mean IM/SC ratio: 1.089 [90% CI, 1.020–1.162]). Other PK and PD parameters were similar between administration routes, although moderate to high inter-subject variability was observed for IM and SC. Safety profiles were generally balanced between IM and SC administration. ISRs occurred at a lower frequency with IM [14.4% (95% CI, 8.89–21.56%)] than with SC [32.1% (95% CI, 24.29–40.70%)] administration ( p = 0.0005). Conclusions: These results demonstrate bioequivalence between peginterferon beta-1a IM and SC and support the consideration of IM injection of peginterferon beta-1a as a viable treatment option in patients with RRMS and RMS.

BackgroundThe lack of availability of evidence-based services for people exposed to adversity globally has led to the development of psychological interventions with features that will likely make them more scalable. The evidence for the efficacy of e-mental health from high-income countries is compelling, and the use of these interventions could be a way to increase the coverage of evidence-based psychological interventions in low- and middle-income countries. Step-by-Step is a brief (5-session) intervention proposed by the World Health Organization as an innovative approach to reducing the suffering and disability associated with depression. ObjectiveThis study aims to evaluate the effectiveness and cost-effectiveness of a locally adapted version of Step-by-Step with Syrian nationals (trial 1) and Lebanese nationals and other populations residing in Lebanon (trial 2). MethodsThis Step-by-Step trial involves 2 parallel, two-armed, randomized controlled trials comparing the e-intervention Step-by-Step to enhanced care as usual in participants with depressive symptoms and impaired functioning. The randomized controlled trials are designed and powered to detect effectiveness in 2 populations: Syrians in Lebanon (n=568) and other people residing in Lebanon (n=568; Lebanese nationals and other populations resident in Lebanon). The primary outcomes are depressive symptomatology (measured with the Patient Health Questionnaire-9) and functioning (measured with the World Health Organization Disability Assessment Scale 2.0). Secondary outcomes include anxiety symptoms, posttraumatic stress disorder symptoms, personalized measures of psychosocial problems, subjective well-being, and economic effectiveness. Participants are mainly recruited through online advertising. Additional outreach methods will be used if required, for example through dissemination of information through partner agencies and organizations. They can access the intervention on a computer, tablet, and mobile phone through a hybrid app. Step-by-Step has 5 sessions, and users are guided by trained nonspecialist “e-helpers” providing phone-based or message-based support for around 15 minutes a week. ResultsThe trials were funded in 2018. The study protocol was last verified June 20, 2019 (WHO ERC.0002797) and registered with ClinicalTrials.gov (NCT03720769). The trials started recruitment as of December 9, 2019, and all data collection was completed in December 2020. ConclusionsThe Step-by-Step trials will provide evidence about the effectiveness of an e-mental health intervention in Lebanon. If the intervention proves to be effective, this will inform future scale-up of this and similar interventions in Lebanon and in other settings across the world. Trial RegistrationClinicalTrials.gov NCT03720769; https://clinicaltrials.gov/ct2/show/NCT03720769 International Registered Report Identifier (IRRID)DERR1-10.2196/21585

BackgroundA growing number of parents refuse vaccination due to concerns about side effects. Influenza vaccine is no exception and remains one of the most controversial vaccines. Data regarding influenza vaccine uptake and parental knowledge, attitude and practice towards vaccination in the Lebanese population is lacking. The aim of this study was to assess the rate of vaccination refusal and potential associated factors among Lebanese parents of school-aged children, in general and with a focus on influenza vaccine.MethodsA parent questionnaire was distributed in randomly selected 2 public and 2 private schools from the greater Beirut area during the school year 2017-2018. Questionnaires covered knowledge, attitude (including themes of efficacy, hesitancy and trust), and practice of vaccination in general and influenza vaccine in particular.ResultsThe response rate was 76.5% (306/400). Overall, 29.4% parents reported vaccinating their children against influenza (62.2% in private and 37.7% in public schools). Younger age, paternal employment and higher household income were associated with higher vaccination rates (p = 0.01, 0.02 and ConclusionOne third of parents of school aged children in the greater Beirut area vaccinate their children against influenza. This rate is likely lower in rural remote areas. Physician's recommendation is the single most important predictor of such vaccination. Future studies tackling physicians' attitude and practice are needed to help improve influenza vaccination rates in the Lebanese population.

The scholarly literature in higher education has not dealt extensively with the responsibilities of institutions for servicing the rights of international students. This paper is a comparative analysis of legal frameworks which guide institutions in their handling of international student rights. Two national approaches, those of Australia and New Zealand, are used as a comparative analysis from which implications are drawn for institutions in other countries. The comparison indicates increasing legalism in higher education, though more law does not necessarily coincide with better rights for students. Also indicated is the importance of institutions providing more and better information to students on rights. More generally the analysis implores institutions to form, and work with, a critical understanding of the law and policy agendas of governments.

Background During the COVID-19 pandemic, the Lebanese government has taken the proactive anticipatory measure to minimize the infection rates. Despite the pivotal role of the pharmacists working in hospital settings, hospital pharmacists have not been engaged in the emergency preparedness for hospitals. The primary objective of this survey is to assess the knowledge, attitude, and practice of hospital pharmacists in Lebanon towards COVID-19 pandemic and explore the level of health emergency preparedness of Lebanese hospitals in response to this outbreak. Methods A standardized English-based, anonymous and online questionnaire was diffused via social media platforms to all Lebanese hospital pharmacists. The questionnaire consisted of 78 questions related to sociodemographic characteristics, knowledge-based, attitude-based, practice questions, and pandemic preparedness. Descriptive statistical analysis was used to summarize data. Results A total of 81 questionnaires were completed; the participants were able to know > 90% of the knowledge-based questions regarding COVID-19. Most of the respondents were concerned about getting infected and their families due to their professional exposure. Similarly, around 67% were following the safety recommendations. Most of the participants agreed that they are facing shortages, rising prices, and delays in supply of masks and sanitizers. In terms of COVID-19 readiness, about 50% of hospitals have taken practical steps. Conclusions Our findings revealed an appropriate level of knowledge and good practice towards COVID-19, among the respondents from Lebanese hospitals. National organizations may benefit in utilizing the expertise of the hospital pharmacists to be able to minimize/avoid future waves of COVID-19 if it emerges.

Abstract Background Studies suggests a possible link between vaginal discharge and common mental distress, as well as highlight the implications of the subjective burden of disease and its link with mental health. Methods/Design This is a community-based intervention trial that aims to evaluate the impact of a psycho-social intervention on medically unexplained vaginal discharge (MUVD) in a group of married, low-income Lebanese women, aged 18-49, and suffering from low to moderate levels of anxiety and/or depression. The intervention consisted of 12 sessions of structured social support, problem solving techniques, group discussions and trainer-supervised relaxation exercises (twice per week over six weeks). Women were recruited from Hey el Selloum, a southern disadvantaged suburb of Beirut, Lebanon, during an open recruitment campaign. The primary outcome was self-reported MUVD, upon ruling out reproductive tract infections (RTIs), through lab analysis. Anxiety and/or depression symptoms were the secondary outcomes for this trial. These were assessed using an Arabic validated version of the Hopkins Symptoms Checklist-25 (HSCL-25). Assessments were done at baseline and six months using face-to face interviews, pelvic examinations and laboratory tests. Women were randomized into either intervention or control group. Intent to treat analysis will be used. Discussion The results will indicate whether the proposed psychosocial intervention was effective in reducing MUVD (possibly mediated by common mental distress). Trial Registration The trial is registered at the Wellcome Trust Registry, ISRCTN assigned: ISRCTN: ISRCTN98441241

This study deals with a seemingly obvious topic to everyone – examples. Yet, on a closer perusal, the topic turns out to be interestingly perplexed. This can be justified by the amalgam of cognition and communication out of which such concept is delivered. This mixture gives a hand in texturizing examples. This work aims at pragmatically investigating the concept of ‘example’ as far as its definition, structure, types and functions are concerned. Furthermore, it aims at developing an eclectic model that will be utilized to pragmatically analyze the data of the work represented by four interviews with Donald Trump in 2018. Consequently, it hypothesizes the following: complex schema is more frequently used in the data; abductive inference is never employed in the data; faulty analogy is never made in the data; the interpersonal variant of the global type of examples is more frequently found in the data; explicit examples are more commonly given; and, finally, the argumentative function of examples prevails. Afterwards, the percentage equation is employed to statistically calculate the results of the analysis. The study has come up with many conclusions, out of which is that examples, once chosen meticulously, support the cogency of argumentation by means of strengthening and boosting one’s standpoints towards the alleged goals.

Pollution from anthropogenic marine debris, particularly buoyant plastics, is ubiquitous across marine ecosystems. Due to the persistent nature of plastics in the environment, their buoyancy characteristics, degradation dynamics, and ability to mimic the behavior of natural prey, there exists significant opportunity for marine organisms to ingest these man-made materials. In this study we examined gastrointestinal (GI) tracts of 42 post-hatchling loggerhead (Caretta caretta) sea turtles stranded in Northeast Florida. Necropsies revealed abundant numbers of plastic fragments ranging from 0.36 to 12.39 mm in size (length), recovered from the GI tracts of 39 of the 42 animals (92.86%), with GI burdens ranging from 0 to 287 fragments with a mass of up to 0.33 g per turtle. Post-hatchlings weighed from 16.0 to 47.59 g yielding a plastic to body weight percentage of up to 1.23%. Several types of plastic fragments were isolated, but hard fragments and sheet plastic were the most common type, while the dominant frequency of fragment color was white. Fragment size and abundance mixed with natural gut contents suggests significant negative health consequences from ingestion in animals at this life stage. Gaining greater insight into the prevalence of plastic ingestion, the types of plastic and the physiological effects of plastic consumption by multiple life-stages of sea turtles will aid the prioritization of mitigation efforts for the growing marine debris problem. This report demonstrates that plastic ingestion is a critical issue for marine turtles from the earliest stages of life.

بدأت منذ عشرات السنين أعمال البحث في مخابر مختلفة في العالم حول مادة البيتون المسلح بألياف: زجاجية، بلاستيكية، فولاذية، كربونية، بهدف استخدامها في المنشآت المدنية، فهي تزيد مقاومة البيتون على الضغط والشد، لكن الدور الأساسي للألياف يكمن في تحسين سلوكه وتحويله من مادة هشة إلى مادة لدنة. تترافق في الجوائز عزوم الانعطاف مع قوى القص, فيلزم تأمين مقاومة قص كافية لتجنب حدوث أي شكل من أشكال الانهيار المفاجئ الناتجة عن القص, أجريت حديثاً عدة دراسات لتحسين مقاومة الجوائز البيتونية على القص شمل بعضها إضافة الألياف الفولاذية والزجاجية والكربونية إلى البيتون. يقدم هذا البحث دراسة تجريبية و تحليلية لإضافة ألياف الكربون إلى بيتون الجوائز غير المسلحة على القص بهدف تقييم أثرها على مقاومة القص للجوائز البيتونية. وقد جرى اختبار 15 جائزاً بيتونياً أضيف إلى بيتونها ألياف الكربون بنسب حجمية مختلفة هي(0.00-0.25-0.5-0.75-1)%، وذلك ضمن مجموعات تحوي كل مجموعة 3 جوائز لكل نسبة. أدت إضافة ألياف الكربون إلى زيادة الحمولات المسببة لشق الانعطاف الأول بنسبة (20-30)% وزيادة الحمولات المسببة لشق القص الأول بنسبة (16.7-33.3)% وكذلك حمولة الانهيار بنسبة (10.8-32.3)% مقارنة مع الجائز غير المقوى بالألياف، وكان هناك توافق جيد بين النتائج التجريبية والتحليلية في مراحل التحميل كافةً.

BackgroundE-mental health is an established mode of delivering treatment for common mental disorders in many high income countries. However, evidence of its effectiveness in lower income countries is lacking. This mixed methods study presents lessons learned and preliminary data on the feasibility of a minimally guided e-mental health intervention in Lebanon. The aim was to pilot test Step-by-Step, a WHO guided e-mental health intervention, and research methods prior to future, controlled testing.MethodsParticipants were recruited using social media and advertisements in primary care clinics. Participants completed baseline and post-intervention questionnaires on depression symptoms (primary outcome, PHQ-8), anxiety symptoms, well-being, disability and self-perceived problem severity, and a client satisfaction questionnaire. In addition, seven completers, four drop-outs, 11 study staff, and four clinic managers were interviewed with responses thematically analyzed. Website analytics were used to understand participant behavior when using the website.ResultsA total of 129 participants signed up via the Step-by-Step website. Seventy-four participants started session 1 after completing pre-test questionnaires and 26 completed both baseline and post-intervention data. Among those who completed post-assessments, depression symptoms improved (PHQ-8 scores (t=5.62, p < 0.001 two-tailed, df = 25). Wilcoxon signed ranks tests showed a significant difference between baseline and post-Step-by-Step scores on all secondary outcome measures. Client satisfaction data was positive. Interview responses suggested that the intervention could be made more appropriate for younger, single people, more motivating, and easier to use. Those who utilized the support element of the intervention were happy with their relationship with the non-specialist support person (e-helper), though some participants would have preferred specialist support. E-helpers would have liked more training on complex cases. Website analytics showed that many users dropped out before intervention start, and that some re-entered screening data having been excluded from the study.ConclusionStep-by-Step skills and techniques, model of service integration, and its non-specialist support element are acceptable. Though the sample was small and non-controlled and drop-out was high, results suggest that it may be effective in reducing depression and anxiety symptoms and increasing well-being. Lessons learned will inform content revision, the development of an app version of Step-by-Step, and the research methodology of upcoming effectiveness studies.

In the present study, we describe the identification of potential citrate metabolism pathways for the lactic acid bacterium (LAB) Carnobacterium maltaromaticum. A phenotypic assay indicated that four of six C. maltaromaticum strains showed weak (Cm 6-1 and ATCC 35586) or even delayed (Cm 3-1 and Cm 5-1) citrate utilization activity. The remaining two strains, Cm 4-1 and Cm 1-2 gave negative results. Additional analysis showed no or very limited utilization of citrate in media containing 1% glucose and 22 or 30 mM citrate and inoculated with Cm 6-1 or ATCC 35586. Two potential pathways of citrate metabolism were identified by bioinformatics analyses in C. maltaromaticum including either oxaloacetate (pathway 1) or tricarboxylic compounds such as isocitrate and α-ketoglutarate (pathway 2) as intermediates. Genes encoding pathway 1 were present in two out of six strains while pathway 2 included genes present in all six strains. The two potential citrate metabolism pathways in C. maltaromaticum may potentially affect the sensory profiles of milk and soft cheeses subjected to growth with this species.

The spreading global sea turtle fibropapillomatosis (FP) epizootic is threatening some of Earth’s ancient reptiles, adding to the plethora of threats faced by these keystone species. Understanding this neoplastic disease and its likely aetiological pathogen, chelonid alphaherpesvirus 5 (ChHV5), is crucial to understand how the disease impacts sea turtle populations and species and the future trajectory of disease incidence. We generated 20 ChHV5 genomes, from three sea turtle species, to better understand the viral variant diversity and gene evolution of this oncogenic virus. We revealed previously underappreciated genetic diversity within this virus (with an average of 2035 single nucleotide polymorphisms (SNPs), 1.54% of the ChHV5 genome) and identified genes under the strongest evolutionary pressure. Furthermore, we investigated the phylogeny of ChHV5 at both genome and gene level, confirming the propensity of the virus to be interspecific, with related variants able to infect multiple sea turtle species. Finally, we revealed unexpected intra-host diversity, with up to 0.15% of the viral genome varying between ChHV5 genomes isolated from different tumours concurrently arising within the same individual. These findings offer important insights into ChHV5 biology and provide genomic resources for this oncogenic virus.

Lereng adalah suatu permukaan tanah yang miring dan membentuk sudut tertentu terhadap suatu bidang horizontal. Pada tempat dimana terdapat dua permukaan tanah yang berbeda ketinggian, maka akan ada gaya yang bekerja mendorong sehingga tanah yang lebih tinggi kedudukannya cenderung bergerak ke arah bawah. Hal ini disebut dengan gaya potensial gravitasi yang menyebabkan terjadi kelongsoran. Kabupaten Tabanan memiliki beberapa ruas jalan yang melewati lereng, salah satunya adalah ruas Jalan Raya Bedugul. Ruas jalan ini merupakan ruas jalan penghubung antara Kabupaten Buleleng, Kabupaten Badung dan Kabupaten Tabanan. Telah terjadi kelongsoran pada lereng ini, tepatnya di KM 49 + 800 di Desa Candikuning, Kecamatan Baturiti, Kawasan Wisata Danau Beratan yaitu pada tanggal 21 Desember 2016 dan longsor susulan pada tanggal 10 Februari 2017. Untuk mencegah kemungkinan terjadinya longsor susulan yang sewaktu-waktu dapat terjadi lagi, maka perlu dilakukan langkah antisipasi dengan merencanakan perkuatan pada lereng tersebut. Pada studi ini dianalisis kekuatan geser tanah dengan perkuatan, untuk dapat mengetahui kemampuan perkuatan dalam menjaga kestabilan lereng. Juga dilakukan analisis kestabilan lereng di lokasi penelitian dengan tujuan dapat mengetahui kemampuan penggunaan perkuatan sebagai alternatif dalam mengatasi kelongsoran pada lereng tersebut. Berdasarkan analisis setelah dinding penahan diperkuat dengan barisan tiang bor diperoleh angka stabilitas terhadap guling dan geser lebih besar daripada 1,5 dan stabilitas terhadap daya dukungnya lebih kecil daripada daya dukung tanah yang diijinkan sehingga dinding penahan aman terhadap bahaya kelongsoran.

Background: Prostate cancer (PC) is a common noncutaneous malignancy in men. The incidence of PC is increasing at an alarming rate across the globe. Progression of PC is associated with elevated levels of interleukin-8 (IL-8) and cyclooxygenase-2 (COX-2) in malignant cells. Overexpression of these players is accompanied by chronic inflammation, increased angiogenesis, proliferation, migration, and inhibition of apoptosis. Moreover, their elevated circulating levels promote the disease progression from androgen-dependent to androgen-independent state. Thus, inhibiting the expression of IL-8 and COX-2 would be a promising target in the development of PC therapeutics. In this study, we investigated the inhibitory effects of Withania somnifera extract on highly metastatic, androgen-independent prostate cancer cell line (PC3). Additionally, we compared the real-time expression of IL-8 and COX-2 in prostate tissue samples. Materials and methods: The cell viability and cytotoxicity of W. somnifera extract in PC3 cells was quantified colorimetrically by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide and lactate dehydrogenase leakage assay, respectively. Hematoxylin and eosin staining for histological examination, trypan blue, and acridine orange dyes to enumerate apoptotic and live cells, quantitative real-time polymerase chain reaction to determine the expression and flow cytometry to study the cell cycle analysis were used. Results: We observed a significant decrease in the cell viability with a half-maximal inhibitory concentration (IC50) of 10 μg/mL. The expression levels of IL-8 and COX-2 in prostate tissue samples and in PC3 cells were predominantly high; however, the lowest dose of W. somnifera significantly inhibited the enhanced expression of IL-8 and COX-2 in PC3 cells in 24 hours. Furthermore, W. somnifera extract (10 μg/mL) irreversibly arrested the cell cycle in G2/M phase, which was evident from the rapid accumulation of PC3 cells significantly. Conclusion: Our results indicate that inherent metastatic and selective inhibitory potential of W. somnifera against PC. W. somnifera may be a good therapeutic agent in addition to the existing drugs for PC. Further studies with more prostate tissue samples are warranted.

Satius enim esse impunitum relinqui facinus nocentis quam innocentem damnari és una cèlebre sentència llatina, transmesa per Ulpiano, que plasma la idea general que és subjacent a la presumpció d'innocència. La màxima se cita amb certa freqüència en els treballs que tracten aquest particular, i sovint es fa amb variants incorrectes des d'un punt de vista lingüístic. En aquest article ens proposem adonar-nos-en de les principals vacil·lacions trobades en treballs especialitzats i exposar, en la mesura possible, algunes de les raons que les motivarien.

Situs inversus totalis is a congenital anatomic anomaly characterized by a complete inversion of thoracic and abdominal organs. We present a case of a 67 year-old patient diagnosed with situs inversus totals in his childhood who was referred for a two-month history of hematoquezia. Ascending colon cancer where found and he underwent a laparoscopic hemicolectomy with radical lymphadenectomy. An exhaustive preoperative study and a detailed planning of laparoscopic surgery including positions of operator and assistants and trocar sites have been performed to be aware of anatomic challenges. The operating time was 120 min and blood loss was minimal. Histologic examination showed a well-differentiated adenocarcinoma with serosal invasion and without lymph nodes metastasis (pT3N0). The patient was discharged on postoperative 6th day without complications. Laparoscopic surgery for colon cancer in patients with situs inversus totalis could be more difficult nevertheless a safe and feasible procedure should be performed successfully. Resumo: Situs inversus totalis é uma anomalia anatómica consistindo em um investimento de órgãos abdominais. Nesse estudo, descrevemos um paciente, homem 67 anos, que foi diagnosticado com situs inversus totalis na infância. Apresentava sintomas de sangramento retal e foi diagnosticado com câncer de cólon direito e tratado cirurgicamente com receção laparoscópica. Para a realização da colectomia laparoscopica precisamos de um estudo pré-operatória completa e um plano detalhado de cirurgia com localização do trocateres e cirurgiões. A cirurgia durou 120 minutos e perde de sangue foi mínima. O resultado do exame patológico relatou adenocarcinoma (T3N0). Nosso paciente foi admitido por 7 dias e não apresentaram complicações. Para os pacientes com situs inversus totalis e câncer colorretal a receção laparoscópica pode ser mais difícil mas eficaz e segura. Keywords: Colorectal cancer, Situs inversus totalis, Laparoscopic surgery, Laparoscopic hemicolectomy, Congenital anomaly, Palavras-chave: Câncer Colorretal, Situs inversus totalis, Cirurgia laparoscópica, Malformação congênita

The rule of Andalusia during the period(138-172 AH/756-788 AD), the Umayyad prince Abdul Rahman bin Muawiya bin Hisham bin Abdul Malik, nicknamed Al- dakhl, who survived the oppression of the Abbasids and managed to establish an Umayyad Emirates in Andalusia separate from the Abbasid Caliphate in Baghdad, but not soon That Andalusia faced during the reign of Prince Abdul Rahman, a number of internal risks and challenges aimed at its security and civilization and therefore the Islamic presence in it represents the most serious revolutions against him, which supported by the Abbasid caliphate in Baghdad, which led to negative results for the Muslim Arabs in Andalusia. حكم الأندلس خلال الفترة (138-172هـ / 756-788م)، الأمير الأموي عبد الرحمن بن معاوية بن هشام بن عبد الملك الملقب بالداخل ، الذي نجا من بطش العباسيين وتمكن من تأسيس إمارة أموية في الأندلس منفصلة عن الخلافة العباسية في بغداد، ولكن لم تلبث أن واجهت الأندلس خلال عهد الأمير عبد الرحمن، جملة من المخاطر والتحديات الداخلية التي استهدفت أمنها وحضارتها وبالتالي الوجود الإسلامي فيها تمثل أخطرها بالثورات التي قامت ضده والتي دُعمت من قبل الخلافة العباسية ببغداد، مما أفضى إلى نتائج سلبية بالنسبة للعرب المسلمين في الأندلس.

Between 5 and 6 December 2019 the International Symposium “Social impact and the social sciences: Theory and practice in the era of propaganda, fake news and media manipulation” was held at the University of Bucharest. Parallel sessions were held throughout the two days, canvassing a range of important contemporary issues in the advancement of social impact. These included: the role of theory in analysing impact in the context of political propaganda; the challenges of online and offline strategies to tackle fake news and media manipulation; and the importance of evidence-based social impact programs in and for organisations in the government and non-profit sectors. Some discussions focused on regional issues, including the Black Sea area and the EU. Others focused on country-specific interventions with social impact. Additional presenters debated issues on fake news, media manipulation and social impact at the trans-national and global levels. In concluding the conference, Professor Marian Zulean and Dr Gaby Ramia, two of the conference organisers, announced that a conference discussing social issues in the Black Sea region is likely to be organised in May 2020, and the 2020 iteration of the conference will be organised for the Fall in 2020.

Construction of an optimal vaccine against tumors relies on the availability of appropriate tumor-specific antigens capable to stimulate CD4+ T helper cells (TH) and CD8+ cytolytic T cells (CTL). CTL are considered the major effectors of the anti-tumor adaptive immune response as they recognize antigens presented on MHC class I (MHC-I) molecules usually expressed in all cells and thus also in tumors. However, attempts to translate in clinics vaccination protocols based only on tumor-specific MHC-I-bound peptides have resulted in very limited, if any, success. We believe failure was mostly due to inadequate triggering of the TH arm of adaptive immunity, as TH cells are necessary to trigger and maintain the proliferation of all the immune effector cells required to eliminate tumor cells. In this review, we focus on a novel strategy of anti-tumor vaccination established in our laboratory and based on the persistent expression of MHC class II (MHC-II) molecules in tumor cells. MHC-II are the restricting elements of TH recognition. They are usually not expressed in solid tumors. By genetically modifying tumor cells of distinct histological origin with the MHC-II transactivator CIITA, the physiological controller of MHC-II gene expression discovered in our laboratory, stable expression of all MHC class II genes was obtained. This resulted in tumor rejection or strong retardation of tumor growth in vivo in mice, mediated primarily by tumor-specific TH cells as assessed by both depletion and adoptive cell transfer experiments. Importantly these findings led us to apply this methodology to human settings for the purification of MHC-II-bound tumor specific peptides directly from tumor cells, specifically from hepatocarcinomas, and the construction of a multi-peptide (MHC-II and MHC-I specific) immunotherapeutic vaccine. Additionally, our approach unveiled a noticeable exception to the dogma that dendritic cells are the sole professional antigen presenting cells (APC) capable to prime naïve TH cells, because CIITA-dependent MHC-II expressing tumor cells could also perform this function. Thus, our approach has served not only to select the most appropriate tumor specific peptides to activate the key lymphocytes triggering the anti-tumor effector functions but also to increase our knowledge of intimate mechanisms governing basic immunological processes.

Resumo Hemangioma é um tumor frequente, geralmente diagnosticado em crianças, constituindo quase 10% das neoplasias benignas. Um hemangioma com crescimento na parede de um vaso é extremamente raro, e deve ser diferenciado de outras malformações vasculares de mesma origem. Apresentamos um caso raro de hemangioma de veia jugular externa e discutimos sua propedêutica e manejo.

Hepatocellular carcinoma (HCC) is the second cause of death for cancer worldwide, justifying the urgent need for novel therapeutic approaches. Immunotherapeutic strategies based on triggering and/or rescuing tumor antigen-specific T cells may be promising particularly if combined together. As preliminary step toward this goal, we have investigated the expression of antigen presenting molecules (HLA class I and class II) and immune checkpoints (PD-1 and PD-L1) in 43 HCC samples from distinct patients and in HCC cell lines. While normal hepatocytes did not express HLA class I and II, HCC cells strongly upregulated HLA class I while remaining negative for HLA class II. The absence of HLA class II expression in HCC cell lines correlated with lack of expression of the HLA class II transactivator, CIITA, which could not be rescued even after interferon-gamma treatment. This was due to high methylation levels of interferon-gamma-sensitive CIITA promoter IV strongly suggesting a biologically relevant developmental silencing of HLA-II expression in liver cell lineage. HCC tumor tissues showed a variable degree of leukocyte infiltration. Infiltrating lymphocytes expressed PD-1, while PD-L1 was expressed in cells with monocyte-macrophage morphology mostly localized at the tumor margin, but not in tumor cells. De novo expression of HLA class I, instrumental for presenting tumor antigens to cytotoxic T lymphocytes, and the correct characterization of the cells expressing checkpoint inhibitors in the tumor tissue should be the ground for setting novel strategies of combined approaches of immunotherapy in HCC based on tumor peptide vaccines and anti-checkpoint inhibitor antibodies.