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Abstract Background The “Iron Swords” War beginning in October 2023 led to unprecedented levels of shock and trauma across Israel, significantly impacting the Israeli population and medical personnel. This study aimed to evaluate and compare the perceived personal resilience and sense of danger among physicians in hospitals located in different conflict zone proximities in Israel during this period. Methods A quantitative, cross-sectional study was conducted from March to August 2024, during an active phase of the war, using a structured anonymous questionnaire. Participants were 161 physicians from three hospitals: one in southern Israel near the Gaza Strip, another in northern Israel near the borders with Lebanon, Syria, and Jordan, and a third in central Israel near Tel Aviv. The survey measured personal resilience using the Connor-Davidson Resilience Scale (CD-RISC-10) and sense of danger using the Solomon & Prager scale. Statistical analyses included Kruskal-Wallis H test, multiple linear regression, two-way analysis of variance (ANOVA), and Sobel test for mediation effects. Results The final sample included 161 physicians (54 southern, 56 central, 51 northern). The mean resilience score was 31.14 ± 5.77, and the mean sense of danger score was 8.36 ± 4.15 (scales 0–40 and 0–20, respectively). Physicians in the southern hospital reported significantly higher sense of danger scores (p = 0.005). A trend towards lower resilience scores was noted among southern hospital physicians (p = 0.068) (p = 0.068). Two-way ANOVA revealed significant main effects of hospital location and gender on resilience (p = 0.046 and p = 0.003, respectively) and sense of danger (p = 0.005 and p = 0.062, respectively). Multiple regression analysis identified hospital location (β = -0.178, p = 0.023) and gender (β = 0.229, p = 0.004) as significant predictors of resilience. Mediation analysis indicated that personal resilience partially mediated the relationship between hospital location and sense of danger (indirect effect = 0.2896, p

Cryptantha whippleae D.A.York & M.G.Simpson (Boraginaceae) is described as new. This species is currently known to occur in serpentine barrens in the Shasta-Trinity National Forest of Siskiyou County, California, with one outlier population in possible serpentine of Lake County, California. The new species is most similar to Cryptantha grandiflora and to C. milobakeri, these three likely each others’ closest relatives. All three have a relatively large corolla limb width and similar smooth, lance-ovate to ovate, marginally rounded, acuminate and abaxially transversely flattened nutlets. Cryptantha whippleae differs from C. grandiflora in having a short, as opposed to a tall, stem height; bifurcate as opposed to trifurcate primary axis cymules; and typically 2–3 nutlets per fruit, as opposed to usually one nutlet per fruit. Cryptantha whippleae differs from C. milobakeri also in having a short, versus tall, stem height; appressed-strigose and spreading-hispid stem vestiture, as opposed to strigose only or strigose and hirsute; calyx trichomes with two distinct vestiture types, these marginally appressed hirsute and medially hispid, as opposed to calyx trichomes of one type, dense, appressed to ascending, whitish sericeous; and 2–3 nutlets per fruit, as opposed to one nutlet per fruit. Cryptantha whippleae is relatively rare and joins seven other Cryptantha species that are found on serpentine, either obligately or facultatively. Current molecular phylogenetic studies support the mostly convergent evolution of serpentine adaptation in Cryptantha, but additional studies are needed.

Abstract Introduction Gram-negative bacteremia is a life-threatening infection with high morbidity and mortality. Its incidence is rising worldwide, and treatment has become more challenging due to emerging bacterial resistance. Little data is available on the burden and outcome of such infections in Lebanon. Methods We conducted this retrospective study in four Lebanese hospitals. Data on medical conditions and demographics of 2400 patients diagnosed with a bloodstream infection based on a positive blood culture were collected between January 2014 and December 2020. Results Most bacteremias were caused by Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii, with the more resistant organisms being hospital-acquired. Third-generation cephalosporin and quinolone resistance was steady throughout the study, but carbapenem resistance increased. Mortality with such infections is high, but carbapenem resistance or infection with Pseudomonas or Acinetobacter species were significant risk factors for poor outcomes. Conclusion This is the first multi-center study from Lebanon on gram-negative bacteremia, resistance patterns, and factors associated with a poor outcome. More surveillance is needed to provide data to guide empirical treatment for bacteremia in Lebanon.

We evaluated spatial-temporal risk for Lyme disease in northwestern North Carolina, USA, by using individual-level canine Borrelia burgdorferi seroprevalence data collected during 2017–2021 at routine veterinary screenings for tickborne diseases. Seroprevalence in dogs increased from 2.2% (47/2,130) in 2017 to 11.2% (339/3,033) in 2021. The percentage of incident seropositivity increased from 2.1% (45/2,130) in 2017 to 7.6% (231/3,033) in 2021. Exploratory geographic analyses found canine seroprevalence shifted from clustered (2017, Moran’s I = 0.30) to dispersed (2021, Moran’s I = −0.20). Elevation, slope, aspect, and forest land cover density were associated with canine seroprevalence within various household buffer regions in 2017. Slope was associated with seroprevalence at the household level in 2021. Results support the use of individual-level canine seroprevalence data for monitoring human risk for Lyme disease. Establishing sentinel veterinary clinics within Lyme disease–emergent communities might promote prevention and control efforts and provide opportunities for educational and behavioral interventions.

Osteochondromas, the most frequent type of bone tumor, develop from the metaphysis region of bones. Osteochondroma often occurs in bones, however, it is rare when it comes to rib tumors. It is often asymptomatic and observed incidentally.We present a case of a 14-year-old male patient who had been experiencing cough and mild fever for approximately a week. We requested a CXR PA and LAT. It showed a pulmonary nodule measuring 1.5 cm in diameter in the upper segment of the left lower lobe.Taking into account the unclear nature of the diagnosis, we requested CT scan with contrast of the chest to obtain a better view. It showed:The nodule visualized on the CXR corresponded to a posteriorly directed, well-defined lesion arising from the costal cartilage of the third left rib, measuring 1.2 × 1.3 × 1.1 cm, likely representing an osteochondroma.The case we discussed highlights a rib osteochondroma that initially seemed like a pulmonary nodule on an X-ray, pointing out the importance of using CT scans for accurate diagnosis in such cases, and reminding us to consider osteochondroma when we see similar symptoms and to regularly check the tumor with medical imaging after it's been confirmed by a pathological test.

Abstract Neuronal hyperexcitability is a key element of many neurodegenerative disorders including the motor neuron disease Amyotrophic Lateral Sclerosis (ALS), where it occurs associated with elevated late sodium current (INaL). INaL results from incomplete inactivation of voltage-gated sodium channels (VGSCs) after their opening and shapes physiological membrane excitability. However, dysfunctional increases can cause hyperexcitability-associated diseases. Here we reveal the atypical binding mechanism which explains how the neuroprotective ALS-treatment drug riluzole stabilises VGSCs in their inactivated state to cause the suppression of INaL that leads to reversed cellular overexcitability. Riluzole accumulates in the membrane and enters VGSCs through openings to their membrane-accessible fenestrations. Riluzole binds within these fenestrations to stabilise the inactivated channel state, allowing for the selective allosteric inhibition of INaL without the physical block of Na+ conduction associated with traditional channel pore binding VGSC drugs. We further demonstrate that riluzole can reproduce these effects on a disease variant of the non-neuronal VGSC isoform Nav1.4, where pathologically increased INaL is caused directly by mutation. Overall, we identify a model for VGSC inhibition that produces effects consistent with the inhibitory action of riluzole observed in models of ALS. Our findings will aid future drug design and supports research directed towards riluzole repurposing.

Background: During preclinical training, dental students take radiographs of acrylic (plastic) blocks containing extracted patient teeth. With the digitisation of medical records, a central archiving system was created to store and retrieve all x-ray images, regardless of whether they were images of teeth on acrylic blocks, or those from patients. In the early stage of the digitisation process, and due to the immaturity of the data management system, numerous images were mixed up and stored in random locations within a unified archiving system, including patient record files. Filtering out and expunging the undesired training images is imperative as manual searching for such images is problematic. Hence the aim of this stidy was to differentiate intraoral images from artificial images on acrylic blocks. Methods: An artificial intelligence (AI) solution to automatically differentiate between intraoral radiographs taken of patients and those taken of acrylic blocks was utilised in this study. The concept of transfer learning was applied to a dataset provided by a Dental Hospital. Results: An accuracy score, F1 score, and a recall score of 98.8%, 99.2%, and 100%, respectively, were achieved using a VGG16 pre-trained model. These results were more sensitive compared to those obtained initally using a baseline model with 96.5%, 97.5%, and 98.9% accuracy score, F1 score, and a recall score respectively. Conclusions: The proposed system using transfer learning was able to accurately identify “fake” radiographs images and distinguish them from the real intraoral images.

Background: Shoulder dislocations are common occurrences, with anterior shoulder dislocations being the most prevalent. Various reduction techniques are employed, but success rates and influencing factors remain variable. This study aims to evaluate the success rate of anterior shoulder reductions performed by emergency physicians, as well as factors contributing to reduction failure and extended emergency department (ED) stay. Methods: A retrospective cross-sectional study was conducted at King Abdulaziz Medical City from 2019 to 2022, focusing on patients presenting with closed anterior shoulder dislocation. Data were collected from medical records included patient demographics, mechanism of injury, method of reduction, and length of stay in the ED. Statistical analyses explored associations and relationships between variables. Results: A total of 179 patients were included. The mean age was 32 years. Most patients had normal BMI (34.6%), and the right shoulder was more frequently affected (56.4%). Falls (38.0%) and daily activities (33.5%) were common mechanisms of injury. Patients presenting within 3 hours had a mean ED stay of 3 hours and 54 minutes, compared to 6 hours and 43 minutes for those presenting later (p < 0.001). The success rate was 94.8% for early presenters and 84.3% for late presenters. Orthopedic involvement resulted in longer ED stays (8 hours and 48 minutes ± 5 hours and 20 minutes), while those without orthopedic referral had shorter stays (4 hours and 40 minutes ± 3 hours and 17 minutes). The waiting time for outpatient appointments was significantly shorter for patients with orthopedic involvement (8 days) compared to those without (39 days, p < 0.001). Conclusion: Emergency medicine physicians achieved a high success rate in reducing anterior shoulder dislocations. The study underscores the importance of early presentation to the ED and orthopedic involvement in achieving favorable outcomes. The findings contribute to enhancing the understanding and management of closed anterior shoulder dislocations in emergency medicine. [SJEMed 2024; 5(2.000): 119-123]

Abstract Disrupted sleep due to nighttime eating can raise various concerns, impacting both physical health and overall well-being. Nevertheless, there is a lack of direct evidence linking nighttime eating with the female reproduction system, possibly due to the absence of suitable models. Here, we use the laying hen, a diurnal animal maintained under ad libitum feeding, as a vertebrate model to quantify the impact of nighttime eating on reproduction and aging. To do this, we have built an Arduino-based setup that regulates food availability and exclusively tracks the eating events of individuals. Our data indicate that synchronizing food availability with the natural sleep–wake rhythm substantially improves reproduction and extends healthspan in hens. With reproductive aging becoming progressively more prevalent in contemporary society due to the trend of delayed childbearing, synchronizing eating with the natural rhythm could help mitigate reproductive aging in vertebrates and potentially in humans as well.

Abstract Background Dietary supplements (DS) are commonly used to improve overall health status and correct nutritional deficiencies. However, with the global rise in DS use, there is an increased risk of misuse and/or excessive use leading to toxicity and adverse events (AE). Research on DS use and DS-related AE is limited in Kuwait. This study aimed to explore the prevalence of DS use, its associated factors, and reported AE in a population of young adults. Methods A cross-sectional study was carried out using an online self-administered questionnaire. Non-probabilistic sampling was used via multiple social media platforms. Logistic regression analysis was performed to assess the association between sociodemographic, lifestyle characteristics and health status with DS use and AE. Results The prevalence of DS use was 68.24%. DS use was found to be associated with age (odds ratio [OR] = 1.07, 95% confidence interval [CI] 1.03–1.13; p-value [p] =

Background: The COVID-19 pandemic has significantly impacted all areas of life, and graduate education is no exception. Although prior research points to the effectiveness of delivering course content virtually, research on the effect of the unexpected and rapid nature of the transition from in-person to remote social work graduate education during the COVID-19 pandemic is limited. Methods: This qualitative study was conducted through an online open-ended survey in the early weeks of the COVID-19 pandemic. Using purposive sampling, 20 Social Work faculty members were selected from 8 universities in Turkey. An online research-made e-questionnaire with five main essay open-ended questions was used for data gathering. The data was analyzed using qualitative content analysis. Results: In total, 20 social work faculty members aged 24 to 49 participated in this study. The faculty perspective on the students’ online experience during the pandemic highlighted challenges faced by students, such as technical issues, communication difficulties, decreased engagement, and limited participation in school work. Faculty also observed students struggling with mental health, family issues, and pandemic-related financial difficulties. Moreover, faculty noted limitations in their teaching methods, particularly the lack of interaction during lectures. However, faculty identified effective strategies for online teaching, including using a mix of asynchronous video lectures and live discussions, promoting independent student work, reducing course content, and modifying assignments. They also emphasized the benefits of minimizing reliance on traditional lectures and PowerPoint presentations, encouraging students to engage with and analyze information. Conclusion: Findings from this study point to the need for comprehensive institutional support to improve distance learning, including attending to students’ social-emotional learning and a focus on developing faculty skills at teaching in a virtual capacity and may improve how effectively social work programs deliver course content online. Both students and faculty prefer a hybrid approach combining in-person and online methods.

The mutation HBA2:c.*94A>G (AATAAA>AATAAG; rs63751269) is a 3′-UTR (3 prime untranslated region) single-nucleotide substitution in the polyadenylation (PA) signal of HBA2 (αPA:A→G). This pathogenic (CADD score, 14.92) variant is sporadic in the Arabian Peninsula. It results in inefficient mRNA processing, transcription termination, and possibly using an alternate cryptic downstream polyadenylation signal. As a result, the allele αT (or αT-Saudi) poses challenges in premarital counseling with respect to fetal risk of hemoglobin H disease. Homozygous HBA2:c.*94A>G (αTα/αTα) results in moderate-to-severe microcytosis (mean red cell volume, MCV, 55 to 65 fL), reflecting markedly impaired hemoglobin synthesis (hemoglobin H disease). Homozygous rightward −α3.7 (a 3804-neocleotide deletion allele, NM_000517.4:c.[-2_-3delAC; −α3.7]), on the other hand, results in mild microcytosis (MCV, 70 to 75 fL, alpha-thalassemia trait). Thus, HBA2:c.*94A>G is more damaging than −α3.7. Consistently, the value of MCV in compound heterozygosity, HBA2:c.*94A>G and −α3.7, is 65 to 70 fL. We report here a healthy couple who presented for premarital counseling on their hemoglobinopathy. The man has homozygous HBA2:c.*94A>G (αTα/αTα), and the woman has compound heterozygous (−α3.7/αTα, also annotated as: −3.7α/αTα). As a result, the genotype of their offspring would be that of the father (αTα/αTα) or the mother (−α3.7/αTα). The counseling was mainly based on the benign phenotypes of the parents. As both were asymptomatic and their anemia was clinically insignificant, they proceeded with the marriage.

Dyslexia is classed as a neurobiological difficulty and is referred to as a Specific Learning Disability (SPLD) that primarily affects reading, writing, working memory (WM), and organisational skills. Positive psychology interventions (PPIs) have been found to increase self-esteem, self-efficacy, and confidence and lower anxiety among students with dyslexia. Therefore, to summarise the current evidence on PPIs, a narrative review was undertaken. The review synthesised the findings from six studies that investigated PPIs for dyslexic individuals across various education settings. Four key themes emerged: (1) characteristics and effectiveness of PPIs, (2) level of education, (3) gender differences, and (4) PPIs differences in Western and Eastern countries. The analysis revealed that group interventions in secondary schools positively impacted self-esteem and social skills among dyslexic pupils, while the efficacy of sunflower therapy for dyslexic children showed inconclusive results on academic performance but potential psychological benefits. Socioemotional wellbeing programmes for dyslexic children yielded mixed outcomes, with temporary increases in self-esteem post-programme. Mindfulness meditation demonstrated promise in improving reading accuracy and attention functions in adults with dyslexia. Positive psychology group interventions effectively enhanced subjective wellbeing, academic self-concept, and achievement among dyslexic children. Early interventions showed promise in improving coping strategies, perceived control, and overall wellbeing among students with dyslexia. This review highlights the potential benefits of diverse interventions across different educational settings, emphasising the importance of early support and targeted interventions for individuals with dyslexia.

Abstract Proteinuria poses a substantial risk for the progression of chronic kidney disease (CKD) and its related complications. Kidneys excrete hundreds of individual proteins, some with a potential impact on CKD progression or as a marker of the disease. However, the available data on specific urinary proteins and their relationship with CKD severity remain limited. Therefore, we aimed to investigate the urinary proteome and its association with kidney function in CKD patients and healthy controls. The proteomic analysis of urine samples showed CKD stage-specific differences in the number of detected proteins and the exponentially modified protein abundance index for total protein (p = 0.007). Notably, specific urinary proteins such as B2MG, FETUA, VTDB, and AMBP exhibited robust negative associations with kidney function in CKD patients compared to controls. Also, A1AG2, CD44, CD59, CERU, KNG1, LV39, OSTP, RNAS1, SH3L3, and UROM proteins showed positive associations with kidney function in the entire cohort, while LV39, A1BG, and CERU consistently displayed positive associations in patients compared to controls. This study suggests that specific urinary proteins, which were found to be negatively or positively associated with the kidney function of CKD patients, can serve as markers of dysfunctional or functional kidneys, respectively.

Abstract Deconvolution methods infer quantitative cell type estimates from bulk measurement of mixed samples including blood and tissue. DNA methylation sequencing measures multiple CpGs per read, but few existing deconvolution methods leverage this within-read information. We develop CelFiE-ISH, which extends an existing method (CelFiE) to use within-read haplotype information. CelFiE-ISH outperforms CelFiE and other existing methods, achieving 30% better accuracy and more sensitive detection of rare cell types. We also demonstrate the importance of marker selection and of tailoring markers for haplotype-aware methods. While here we use gold-standard short-read sequencing data, haplotype-aware methods will be well-suited for long-read sequencing.

Scaffold porosity is a critical factor in replicating the complex in vivo microenvironment, directly influencing cellular interactions, migration, nutrient transfer, vascularization, and the formation of functional tissues. For optimal tissue formation, scaffold design must account for various parameters, including material composition, morphology, mechanical properties, and cellular compatibility. This review highlights the importance of interconnected porosity and pore size, emphasizing their impact on cellular behavior and tissue formation across several tissue engineering domains, such as skin, bone, cardiovascular, and lung tissues. Specific pore size ranges enhance scaffold functionality for different tissues: small pores (∼1–2 µm) aid epidermal cell attachment in skin regeneration, moderate pores (∼2–12 µm) support dermal migration, and larger pores (∼40–100 µm) facilitate vascular structures. For bone tissue engineering, multi-layered scaffolds with smaller pores (50–100 µm) foster cell attachment, while larger pores (200–400 µm) enhance nutrient diffusion and angiogenesis. Cardiovascular and lung tissues benefit from moderate pore sizes (∼25–60 µm) to balance cell integration and nutrient diffusion. By addressing critical design challenges and optimizing pore size distributions, this review provides insights into scaffold innovations, ultimately advancing tissue regeneration strategies.

Neuroschistosomiasis, a rare manifestation of schistosomiasis affecting the central nervous system (CNS), can result in severe neurological complications if not promptly diagnosed and treated. The condition arises due to the development of granulomas around eggs that become lodged within the CNS. Here we present a case report involving a young Filipino individual who had recurrent, uncontrolled seizures, ultimately attributed to neuroschistosomiasis. On magnetic resonance imaging revealed that the patient had brain lesions consistent with neuroschistosomiasis. Concurrently, serologic tests revealed high titres of anti-schistosoma antibodies. Effective treatment encompassed the administration of corticosteroids and praziquantel, leading to a favourable clinical outcome. This case underscores the necessity of considering neuroschistosomiasis in seizure patients, particularly in regions where the condition is prevalent, and highlights the diagnostic and therapeutic complexities posed by the absence of a biopsy.

The desalination of salty water has become a necessary industrial process to overcome the next global shortage in freshwater. In this study, adding a Reheat Solar Collector Cycle (RSCC) to a multi-stage flash plant is used to increase the optimization of the desalination process, improving efficiencies, reducing energy, and increasing the production of freshwater demands to overcome the global crisis of shortage in freshwater. Two projects employ this numerical technique. The first project is conducted in the Al-Khafji multi-stage flash plant in Saudi Arabia with an input mass flow rate of 1 Mkg/h (277.78 kg/s), TDS of 35,000 ppm, and wind velocity of 1 m/s. The second project is conducted in the Gulf of Aqaba in Jordan with an input mass flow rate of 1 Mkg/h (277.78 kg/s), TDS of 40,000 ppm, and wind velocity of 1 m/s. The module of the LS-2 Parabolic Trough Collector (PTC) is used to gain the required energy to heat seawater. The results show that in the Al-Khafji project, an increase of 7.1% in the plant capacity per day and an increase in efficiency from 7.8 to 8.4 were observed. While, in the Gulf of Aqaba, an increase of 7.7% in the plant capacity per day and an increase in efficiency from 7.8 to 8.4 are observed.

BackgroundThe rapid evolution of SARS-CoV-2 imposed a huge challenge on disease control. Immune evasion caused by genetic variations of the SARS-CoV-2 spike protein’s immunogenic epitopes affects the efficiency of monoclonal antibody–based therapy of COVID-19. Therefore, a rapid method is needed to evaluate the efficacy of the available monoclonal antibodies against the new emerging variants or potential novel variants. ObjectiveThe aim of this study is to develop a rapid computational method to evaluate the neutralization power of anti–SARS-CoV-2 monoclonal antibodies against new SARS-CoV-2 variants and other potential new mutations. MethodsThe amino acid sequence of the extracellular domain of the spike proteins of the severe acute respiratory syndrome coronavirus (GenBank accession number YP_009825051.1) and SARS-CoV-2 (GenBank accession number YP_009724390.1) were used to create computational 3D models for the native spike proteins. Specific mutations were introduced to the curated sequence to generate the different variant spike models. The neutralization potential of sotrovimab (S309) against these variants was evaluated based on its molecular interactions and Gibbs free energy in comparison to a reference model after molecular replacement of the reference receptor-binding domain with the variant’s receptor-binding domain. ResultsOur results show a loss in the binding affinity of the neutralizing antibody S309 with both SARS-CoV and SARS-CoV-2. The binding affinity of S309 was greater to the Alpha, Beta, Gamma, and Kappa variants than to the original Wuhan strain of SARS-CoV-2. However, S309 showed a substantially decreased binding affinity to the Delta and Omicron variants. Based on the mutational profile of Omicron subvariants, our data describe the effect of the G339H and G339D mutations and their role in escaping antibody neutralization, which is in line with published clinical reports. ConclusionsThis method is rapid, applicable, and of interest to adapt the use of therapeutic antibodies to the treatment of emerging variants. It could be applied to antibody-based treatment of other viral infections.

Not available.

Abstract Background Infectious bronchitis (IB) is an important disease of poultry, and vaccination is the best method of preventing IB in the poultry industry worldwide. Objectives This study was designed to evaluate cytokine and acute‐phase protein (APP) responses and their correlations with antibody titres following vaccination regimes against IB in the broiler. Materials and Methods Broilers were vaccinated with H120 and 1/96 vaccine strains, and MIX (H120 + 1/96) vaccine strains on Days 0 and 14. Heterophils/lymphocyte (H/L) ratio, APPs including chicken serum amyloid A (SAA), chicken pentraxin 3 (chPTX3), chicken interleukin 1β (IL‐1β), chicken interleukin 6 (IL‐6) levels and antibody titres were measured. Results An increase in the H/L ratio, SAA, chPTX3, IL‐1β and IL‐6 levels in vaccinated groups was observed 1 day after the first (highest rates) and second (lower levels) vaccination up to 3 days in three different patterns and then started to decrease. The results showed an immediate, short‐lived response and moderate increases in all criteria. Changing patterns of APPs were different but in similar pattern after the first and second immunization in vaccinated groups. A positive correlation between all criteria values on Days 1 and 15 with antibody titres on Day 28 may indicate agonistic cross‐regulation. Conclusion Different types of IB vaccines could induce different patterns of APPs responses, which can be used to evaluate immune response outcomes in vaccine design, development and administration. The IL‐6 with the highest increase can be a sensitive parameter and chPTX3 with the high increase could be an important criterion.

IntroductionA clear immune correlate of protection from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has not been defined. We explored antibody, B-cell, and T-cell responses to the third-dose vaccine and relationship to incident SARS-CoV-2 infection.MethodsAdults in a prospective cohort provided blood samples at day 0, day 14, and 10 months after the third-dose SARS-CoV-2 vaccine. Participants self-reported incident SARS-CoV-2 infection. Plasma anti–SARS-CoV-2 receptor-binding domain (RBD) and spike-subunit-1 and spike-subunit-2 antibodies were measured. A sub-study assessed SARS-CoV-2–specific plasma and memory B-cell and memory T-cell responses in peripheral blood mononuclear cells by enzyme-linked immunospot. Comparative analysis between participants who developed incident infection and uninfected participants utilised non-parametric t-tests, Kaplan–Meier survival analysis, and Cox proportional hazard ratios.ResultsOf the 132 participants, 47 (36%) reported incident SARS-CoV-2 infection at a median 16.5 (16.25–21) weeks after the third-dose vaccination. RBD titres and B-cell responses, but not T-cell responses, increased after the third-dose vaccine. Whereas no significant difference in day 14 antibody titres or T-cell responses was observed between participants with and without incident SARS-CoV-2 infection, RBD memory B-cell frequencies were significantly higher in those who did not develop infection [10.0% (4.5%–16.0%) versus 4.9% (1.6%–9.3%), p = 0.01]. RBD titres and memory B-cell frequencies remained significantly higher at 10 months than day 0 levels (p < 0.01).DiscussionRobust antibody and B-cell responses persisted at 10 months following the third-dose vaccination. Higher memory B-cell frequencies, rather than antibody titres or T-cell responses, predicted protection from subsequent infection, identifying memory B cells as a correlate of protection.

Background: The prevalence of Bacteroides fragilis isolates resistant to first-line beta-lactam drugs is increasing, resulting in reduced treatment efficacy. Investigating the bacterial transcriptome and proteome can uncover links between bacterial genes and resistance mechanisms. In this study, we experimentally assessed in vitro the transcriptional and proteomic profiles of B. fragilis exposed to SICs of meropenem, an effective antimicrobial agent, collected from patients with intra-abdominal diseases at Astana City Hospital, Kazakhstan. Methods: B. fragilis was cultured in brain heart infusion broth and sub-cultured every 48 h for 8 days in media with and without meropenem. Total RNA was extracted from the liquid cultures using a commercial RNeasy mini kit, and strand-specific RNA sequencing (RNA-seq) was performed on the DNBSEQ platform. Raw RNA-seq data were retrieved from BioProject No. PRJNA531645 and uploaded to the NCBI Sequence Read Archive (accession no. SRX22081155). Proteins of B. fragilis were extracted and separated using sodium dodecyl sulphate–polyacrylamide gel electrophoresis, followed by analysis of the eluted peptides using liquid chromatography–tandem mass spectrometry. Cluster analysis utilised the Database for Annotation, Visualisation, and Integrated Discovery. Results: The subinhibitory concentration (SIC) of meropenem was determined to be 0.5 μg/L (minimum inhibitory concentration: 1). Mapping of reads to the reference genome identified 2477 expressed genes in all B. fragilis BFR KZ01 samples. Ten differentially expressed genes (DEGs) were common across comparison groups during and post-antibiotic exposure (wMEM vs. MEM2 and MEM2 vs. rMEM8); however, no substantially enriched Gene Ontology terms were identified. The cluster analysis highlighted a significant enrichment cluster (W-0560 oxidoreductase) of DEGs following antibiotic withdrawal. In total, 859 B. fragilis proteins were identified, with the expressions of three proteins, 3-oxoacyl-[acyl carrier protein] reductase, acetyl-CoA carboxylase biotin carboxylase subunit, and beta-ketoacyl-ACP synthase III, being upregulated in the enriched protein folding category. Notably, chaperone proteins such as FKBP-type peptidyl-prolyl cis-trans isomerases (involved in the cis-trans isomerisation of prolyl peptide bonds) and GroES (a co-chaperone functioning with GroEL) were also identified. Conclusions: Under the influence of low doses of antibiotics defense mechanisms are activated which contribute to the emergence of resistance. These results provide insight into the response of B. fragilis to meropenem exposure, mainly at the SIC, contributing to the understanding bacterial survival strategies under stress conditions.

Abstract NRAS and KRAS activating point mutations are present in 10–30% of myeloid malignancies and are often associated with a proliferative phenotype. RAS mutations harbor allele-specific structural and biochemical properties depending on the hotspot mutation, contributing to variable biological consequences. Given their subclonal nature in most myeloid malignancies, their clonal architecture, and patterns of cooperativity with other driver genetic alterations may potentially have a direct, causal influence on the prognosis and treatment of myeloid malignancies. RAS mutations overall tend to be associated with poor clinical outcome in both chronic and acute myeloid malignancies. Several recent prognostic scoring systems have incorporated RAS mutational status. While RAS mutations do not always act as independent prognostic factors, they significantly influence disease progression and survival. However, their clinical significance depends on the type of mutation, disease context, and treatment administered. Recent evidence also indicates that RAS mutations drive resistance to targeted therapies, particularly FLT3, IDH1/2, or JAK2 inhibitors, as well as the venetoclax-azacitidine combination. The investigation of novel therapeutic strategies and combinations that target multiple axes within the RAS pathway, encompassing both upstream and downstream components, is an active field of research. The success of direct RAS inhibitors in patients with solid tumors has brought renewed optimism that this progress will be translated to patients with hematologic malignancies. In this review, we highlight key insights on RAS mutations across myeloid malignancies from the past decade, including their prevalence and distribution, cooperative genetic events, clonal architecture and dynamics, prognostic implications, and therapeutic targeting.

Background and objective: Sulfonamides are a type of antibiotic that are used to treat several infections caused by microorganisms. Sulfonamides are bacteriostatic, meaning they prevent bacterial growth. This study aimed to produce compounds with better antimicrobial activity. Methods: By condensation reaction, Schiff bases were synthesized from sulfonamides (sulfamethoxazole, sulfapyridine, sulfathiazole, sulfadiazine and sulfisoxazole) and vanillin to enhance antimicrobial activity of synthesized compounds. The agar dilution method was used to measuring the minimum inhibition concentration (MIC) of synthesized compounds. Results: The synthesized compounds were characterized by FT-IR, 1H-NMR, 13C-NMR and tested for the antibacterial activity against gram positive bacteria (Staphylococcus aureus), gram negative bacteria (Escherichia coli) and antifungal activity against (Candida albicans). Ciprofloxacin and Fluconazole used as standard drugs for bacteria and fungi. Conclusion: The Schiff base was synthesized, characterized, and exhibited enhanced antimicrobial and antifungal activities.

Abstract Background Nonadherence to therapies and psychological disorders are associated with poor asthma control. This study aims to assess the prevalence of anxiety and depressive symptoms, asthma control, and adherence to inhalers and to investigate whether there is an association of anxiety and depressive symptoms with adherence to inhalers and asthma control. Methods We measured anxiety and depressive symptoms using the Hospital Anxiety and Depression Scale in patients with asthma. Asthma Control Test and the 10-Item Test of Adherence to Inhalers Scale were used to assess levels of asthma control adherence to inhalers, respectively. Univariate and multivariate regression models assessed the associations of anxiety and depressive symptoms with adherence to inhalers and asthma control. Results A total of 287 patients completed the study, of whom 72% were female. The mean ± SD age and body mass index of our study population were 44 ± 13 years and 29 ± 7.2 kg/m2, respectively. Poor adherence to inhaler use was highly prevalent (49.8%; 95% CI: 43.8 to 55.7). The prevalence of anxiety, depression and poor asthma control was 27.2% (95% CI: 22.1 to 32.7), 20.9% (95% CI: 16.3 to 26.1), and 22.7% (95% CI: 17.9 to 27.9), respectively. We found a negative relationship between asthma control and anxiety, and depressive symptoms (adjusted β: -0.25; 95% CI: -0.36 to -0.14; p

Multiple sclerosis (MS) is an autoimmune disease affecting the central nervous system (CNS). The diagnosis of MS is based on clinical signs and symptoms as well as findings in magnetic resonance imaging (MRI) sequences by demonstrating the spatial and temporal dispersion of white matter lesions, which are thought to be typical of MS in distribution, shape, extent, and signal abnormalities. Spinal cord MRI can identify asymptomatic lesions and rule out malignancies or spinal stenosis in patients for whom brain imaging is not helpful in making an MS diagnosis. This study examines the MRI features of Saudi Arabian patients clinically proven to have MS with typical lesions exclusively evident in the spinal cord. This retrospective cross-sectional study was carried out in 151 patients who are confirmed cases of MS based on clinical findings and MRI results. Patients’ MRI data were reviewed from the picture archiving and communication system (PACS). The study revealed that MS incidence was higher in females than males and that the number of people diagnosed with MS increased in middle age. Cervical cord plaques and cervical cord curve straightening were the most frequent changes (67% and 56%, respectively), indicating that MRI can complement and even replace clinical data in MS diagnosis, leading to earlier, more precise diagnoses and speedier starts to treatment.

Abstract Regeneration in the injured spinal cord is limited by physical and chemical barriers. Acute implantation of a multichannel poly(lactide-co-glycolide) (PLG) bridge mechanically stabilizes the injury, modulates inflammation, and provides a permissive environment for rapid cellularization and robust axonal regrowth through this otherwise inhibitory milieu. However, without additional intervention, regenerated axons remain largely unmyelinated (

Abstract Background Despite the increase in disclosures of medical errors, transparency remains a challenge. Recognized barriers include shame, fear of litigation, disciplinary actions, and loss of patient trust. In 2018, the Israeli Ministry of Health initiated a series of workshops about disclosure of medical errors. The workshops involved medical center executives, healthcare providers, patients, and family members of patients who had previously been harmed by a medical error. This study presents the lessons learned about perceived challenges in disclosure of errors in 15 such workshops. Methods Data collection included participant observations in 15 workshops, full audio recordings of all of the workshops, and documentation of detailed field notes. Analysis was performed under thematic analysis guidelines. Results We identified four main themes: “Providers agree on the value of disclosure of a medical error to the patient”; “Emotional challenges of disclosure of medical error to patients”; “The medico-legal discourse challenges transparency”; and “Providers and patients call for a change in the culture regarding disclosure of medical errors”. Participant observations indicated that the presence of a patient who had experienced a tragedy in another hospital, and who was willing to share it created an intimate atmosphere that enabled an open conversation between parties. Conclusion The study shows the moral, human, and educational values of open discourse in a protective setting after the occurrence of a medical error. We believe that workshops like these may help foster a culture of institutional disclosure following medical errors. We recommend that the Ministry of Health extend such workshops to all healthcare facilities, establish guidelines and mandate training for skills in disclosure for all providers.

Healthcare providers in North Carolina, USA, have limited experience diagnosing and managing Lyme disease because few cases occur annually statewide. We outline the prolonged diagnostic course for a patient with locally acquired Lyme disease in North Carolina. This case highlights the need for greater awareness and professional education.

A data set was developed for research on word recognition and comprehension as well as for vocabulary knowledge estimation of Arabic–English bilingual speakers (i.e., an understudied population). Subjective frequency (i.e., familiarity) ratings, which reflect language exposure, were collected from 1000 Arabic–English speakers (age range: 18–25) for the printed words of the Peabody Picture Vocabulary Test (PPVT). They were obtained from speakers who had received at least a score of 6 (i.e., competent user of the English language) on the International English Language Testing System (i.e., IELTS). Reading comprehension scores were also obtained from 61 speakers from the same population. In the developed data set, printed words are displayed with their subjective frequency ratings and comprehension scores alongside objective word properties.

Food-Borne Disease (FBD) is defined as an illness resulting from consuming foods contaminated with bacteria, their toxins, viruses, or parasites. Food poisoning due to improper food handling is a major global public health problem. In Lebanon, numerous challenges affect safe food consumption, with poultry being a common vehicle for many pathogens, such as Salmonella spp. This bacterium can cause serious illnesses, including gastroenteritis, characterized by abdominal pain, vomiting, diarrhea, and fever. This study aimed to examine the Knowledge, Attitudes, and Practices (KAPs) towards poultry handling among households in Beirut, Lebanon, and identify factors influencing KAP levels. A cross-sectional study was conducted through face-to-face interviews with 125 households in different areas of Beirut. The interview was divided into four main parts: sociodemographic characteristics, knowledge, attitudes, and practices. The results showed that consumers' knowledge and practices were inadequate, though their attitude was positive. Participants aged 43–55 had higher odds of having a good knowledge level than those aged 18–29 (OR = 3.889, p = 0.02). Additionally, those with a college education were 7.442 times more likely to have a positive attitude towards food safety compared to those with no formal education (p = 0.005). Most participants (91.2 %) do not regularly check their refrigerator and freezer temperatures. Furthermore, significant associations (p

In the 2019 European Union (EU) renewed Strategy for Central Asia, the promotion of democracy in the post-soviet republics of Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan is singled out as one of the key priorities. This article aims to examine whether there is an alignment between the EU self-perception on democracy promotion and its external perception in local media. The question is addressed through quantitative and qualitative content analysis of the EU key documents for Central Asia and local media outlets from 2019 to 2022, using the Nvivo software. The research findings indicate that both self- and external perceptions align in the context of the EU human rights promotion for Central Asia. Drawing upon these findings, this article argues that the EU democracy promotion endeavours are predominantly grasped in Central Asia within the sphere of human rights, while comprehension of other facets of the EU democracy promotion agenda remains intricate. Consequently, as the EU normative agenda faces ongoing scrutiny within Central Asia, it is advocated that the EU undertake a thorough reassessment of its approach in the region, aiming to foster deeper understanding and alignment with local perceptions.

The false declaration of honey authenticity requires the use of rapid and efficient analytical tools in order to be detected. In this study, the use of a green, rapid and emerging approach for food authentication, FT-Raman spectroscopy, proved to obtain reliable and efficient honey botanical and harvesting year differentiation models, when the spectroscopic data was processed by employing a supervised statistical method, namely Partial Least Squares Discriminant Analysis (PLS-DA). The peaks and bands present in the Raman spectra were discussed based on honey composition. In order to increase the efficiency of the models, different preprocessing methods were used and a variable reduction step was employed. The new authentication approach is capable of distinguishing among four botanical sources and two harvesting periods of honey with a correct prediction rate higher than 97 %. The Raman markers that proved to contribute the most to the discrimination were correlated with the honey composition.

In this study, we address the pressing need to improve e-government services by conducting a comprehensive evaluation of document management practices within the Ministry of Higher Education in the Kurdistan Region of Iraq. Employing structural equation modeling and regression modeling techniques, we assess the effectiveness of key variables using the six factors (digitalization, utility, reliability, efficiency, user satisfaction, and accessibility) under the e-government assessment model. Our findings reveal that user satisfaction and ease of access are pivotal for the success of e-government services, with digitization and efficiency significantly impacting operational effectiveness. Furthermore, it also concerns that without improving the overall user satisfaction, the level of acceptance and use of e-government remains low. High user satisfaction can make a lot of difference in overall engagement besides improving service delivery among organizations. Through insights specific to the Kurdistan Region, we underscore the importance of balancing technical infrastructure with user experience. Our proposed six-factor model offers valuable guidance for policymakers and practitioners globally, aiming to enhance e-government services.

Vitamin D's role extends beyond classical calcium and phosphate homeostasis to encompass a pivotal influence on immune modulation and metabolic health. The mechanisms by which vitamin D exerts these effects involve its conversion to hormonally active calcitriol, which binds intracellular vitamin D receptors, initiating various downstream cascades. In this review, we tease out the evidence showing the relationship between vitamin D deficiency and prediabetes within the context of subclinical inflammation, with a special focus on the novel monocyte-to-HDL ratio (MHR), a novel inflammatory marker reflecting subclinical inflammation. This was based on a thorough literature review using reputable databases covering the period from 1980 to 2024. In light of this, we discuss calcitriol's anti-inflammatory effects and consequently link vitamin D deficiency to both overt and subclinical inflammation. Additionally, the utility of several biomarkers, notably MHR, in investigating this association is also discussed. We further reviewed the role of vitamin D deficiency in precipitating prediabetes and type 2 diabetes mellitus (T2DM) via insulin resistance, decreased insulin synthesis and secretion, and subclinical inflammation. Taken together, this mini review highlights that vitamin D deficiency is significantly associated with subclinical inflammation, playing a critical role in the development of prediabetes and the progression to T2DM. Addressing vitamin D deficiency through appropriate interventions may serve as a preventative measure against the development of prediabetes and T2DM.

Background: The inflammatory changes that underlie the heterogeneous presentations of COVID-19 remain incompletely understood. In this study we aimed to identify inflammatory profiles that precede the development of severe COVID-19, that could serve as targets for optimised delivery of immunomodulatory therapies and provide insights for the development of new therapies. Methods: We included individuals sampled

Background: Extrahepatic biliary neuroendocrine tumors (EBNETs) are rare. We aimed to characterize EBNETs including factors associated with survival. Methods: The National Cancer Database was queried for patients with EBNETs from 2004 to 2016. Patients who underwent resection were examined using Cox proportional hazards regression and the Kaplan-Meier method. We compared overall survival (OS) among patients with EBNETs to those with NETs from other primary sites. Results: Overall, 223 patients with EBNETs were identified. Patients were predominantly male (n = 113, 50.7 %), white (n = 177, 79.4 %) and presented without distant metastasis (n = 182, 81.6 %). The majority underwent operation (n = 127, 57.9 %) with resection of the primary tumor (n = 89, 70 %). Among patients who underwent resection (n = 71), multivariable regression demonstrated older age (HR 1.11, 95 % C.I. 1.04–1.17), lymph node metastases (HR 1.19, 95 % C.I. 1.02–1.38) and poorly/undifferentiated tumors [HR 22.3, 95 % C.I. 3.78–131]) were associated with worse overall survival. Patients with EBNETs experienced abbreviated OS compared to patients with small bowel or pancreas NETs (p

In order to assess how effective information systems are, end-user computing satisfaction (EUCS) is essential. This study evaluates EUCS among 354 employees of the Iraqi Kurdistan Region's (KRI) Ministry of Higher Education and Scientific Research. Through factor analysis, the findings indicate 16-item instrument measuring five core components: content, accuracy, format, ease of use, and timeliness. The results show important patterns and connections, emphasizing how important it is to improve these parts in order to increase user satisfaction. Accuracy had the highest impact on user satisfaction (Standardized Beta = 0.347, p < 0.001), and timeliness were particularly important, while format and ease of use had a direct impact on usability. This study gives useful information for improving IT infrastructure and user support. This will help the Ministry create a better, more efficient, and easier-to-use computer environment that meets the needs and expectations of the workforce. In the end, this will lead to higher productivity and user satisfaction.

The integration of trauma-informed and ethical frameworks in qualitative research concerning survivors of gender-based violence (GBV) within displaced communities is critical. These individuals often bear the weight of traumatic experiences compounded by displacement and associated hardships. Adopting a trauma-informed approach establishes a safe environment, prioritizing survivors’ well-being and respecting their agency and narratives, thereby fostering trust and reducing re-traumatization risks. Ethical considerations ensure the dignity, rights, and cultural sensitivities of participants are upheld, contributing to rigorous and humane research. This integration amplifies survivors’ voices and experiences, enhancing understanding and empathy. Trauma-informed approaches acknowledge the likelihood of trauma in individuals’ lives and prioritize safety without aiming to treat symptoms. Proficient interviewing skills aim to improve comfort, safety, and recall without avoiding challenging questions. Integration of trauma-informed principles across all interview phases is crucial, particularly for individuals experiencing various traumas simultaneously, such as displacement, violence, and ongoing conflict. Drawing from the authors’ experiences and existing literature, this paper advocates for a compassionate and empowering shift in qualitative research methodologies to better engage with survivors of trauma and GBV within displaced communities.

Background Coproduction is defined as patients and clinicians collaborating equally and reciprocally in healthcare and is a crucial concept for quality improvement (QI) of health services. Learning Health Networks (LHNs) provide insights to integrate coproduction with QI efforts from programmes from various health systems.Objective We describe interventions to develop and maintain patient and family partner (PFP) coproduction, measured by PFP-reported and programme-reported scales. We aim to increase percentage of programmes with PFPs reporting active QI work within their programme, while maintaining satisfaction in PFP-clinician relationships.Methods Conducted in the Cystic Fibrosis Learning Network (CFLN), an LHN comprising over 30 cystic fibrosis (CF) programmes, people with CF, caregivers and clinicians cocreated interventions in readiness awareness, inclusive PFP recruitment, onboarding process, partnership development and leadership opportunities. Interventions were adapted by CFLN programmes and summarised in a change package for existing programmes and the orientation of new ones. We collected monthly assessments for PFP and programme perceptions of coproduction and PFP self-rated competency of QI skills and satisfaction with programme QI efforts. We used control charts to analyse coproduction scales and run charts for PFP self-ratings.Results Between 2018 and 2022, the CFLN expanded to 34 programmes with 52% having ≥1 PFP reporting active QI participation. Clinicians from 76% of programmes reported PFPs were actively participating or leading QI efforts. PFPs reported increased QI skills competency (17%–32%) and consistently high satisfaction and feeling valued in their work.Conclusions Implementing system-level programmatic strategies to engage and sustain partnerships between clinicians and patients and families with CF improved perceptions of coproduction to conduct QI work. Key adaptable strategies for programmes included onboarding and QI training, supporting multiple PFPs simultaneously and developing financial recognition processes. Interventions may be applicable in other health conditions beyond CF seeking to foster the practice of coproduction.

Transitioning toward sustainable food systems and sustainable diets is critical in reducing environmental impact and achieving the Sustainable Development Goals established by the United Nations General Assembly. This transition requires collaborative efforts across multiple stakeholders, including the general public’s knowledge and attitudes. To assess the knowledge and attitudes toward food sustainability, we carried out a cross-sectional study among Kuwait University students with a total of 278 participants aged ≥18 years (78% women and 22% men). A validated questionnaire was used for this study. Most respondents (>70%) recognized the concept of “local food” and “environmental impact.” The concept “green water-blue water” was least recognized among respondents (75%). Participants perceived that a sustainable diet was rich in vegetables, included plenty of fresh products, and was affordable. Participants (>66%) perceived a positive impact of meat and its derivatives toward sustainability, a misconception most common among men. Overall, participants with more knowledge about environmental concepts showed favorable attitudes toward a sustainable diet. Women showed more interest in changing their current dietary habits toward food sustainability. In conclusion, despite participants’ positive attitude toward food sustainability, lack of understanding persists, necessitating public health interventions aimed at educating consumers about sustainable diets and their impact on the environment.

This study examines whether, and to what extent, SFAS166/167 changed the role of securitization in bank liquidity and lending activities. We compare the sensitivity of on-balance sheet loan growth to the loan portfolio liquidity index proposed by Loutskina [(2011) The role of securitization in bank liquidity and funding management, Journal of Financial Economics 100, 663–684] between affected banks and control banks. We find that SFAS166/167 is significantly associated with a reduction in the use of securitization to enhance on-balance sheet liquidity, consistent with the view that consolidation on balance sheets may render the securitization of loans too costly to be considered an effective source of liquidity. In addition, we find that affected banks with the highest increase in liabilities from consolidating Qualified Special Purpose Entities (QSPEs) experienced a significant decrease in lending activities relative to the control banks. This is likely because consolidating former QSPEs may adversely affect the ability and willingness of banks to engage in securitization and issue new loans. Taken together, our results suggest that SFAS166/167, requiring the consolidation of former QSPEs, led to a decline in the role of securitization as a liquidity management tool in banks and to a significant decline in lending.

The primary aim of the study was to assess and compare executive functions in psychiatric inpatients (n=65) with those of a matched control group of healthy individuals (n=65). Both cohorts underwent rigorous evaluation using neuropsychological performance-based tests and self-assessment scales. Findings indicated a superior performance by the control group in both self-assessed and computerized evaluations. Notably, there was an absence of correlation between results from the performance-based test (Corsi) and self-assessments of executive function. Subsequent analysis focusing on primary diagnostic categories highlighted that patients diagnosed with depression consistently undervalued their performance in the self-assessment as opposed to the objective, computer-based evaluations. This undervaluation was observed across total scores and individual subscales. In contrast, patients diagnosed with alcohol dependence exhibited a tendency to overestimate their performance in self-assessments relative to the objective tests. The study investigates the causes of these observed differences and considers their implications for subsequent research and clinical practices.

Background Wars, crises, and climate change are just a few of the worldwide concerns that have resulted in the forced relocation of millions of people. After 12 years of conflict in Syria, millions of Syrians are still displaced in the neighbouring countries, and their conditions have worsened due to the economic and socio-political crisis of the region. This paper reports on a study conducted in Lebanon as part of the EU Horizon-funded project ADMIGOV – Advancing Alternative Migration Governance. It describes the methodological framework used to study Syrian migration in Lebanon and sheds light on the phenomenon's patterns, challenges, and impacts. Methods In our study, we opted for a mixed method. It is built on a large corpus of primary data collected over the course of years of intensive, in-depth fieldwork and the author's immersion in the community. Alongside observations, quantitative and qualitative phone interviews were conducted to obtain the perceptions of displaced Syrians living in informal tented settlements in rural Lebanon and an incomplete building in the city of Saida. This interview data is accompanied by primary and secondary data sources, including the findings of other European research projects, statistics from UNHCR and IOM, and academic and press articles. Results Our research revealed the difficulties Syrians displaced in Lebanon encounter while navigating the challenging situation they are trapped in. Based on a case study approach, it unveils similarities and differences determined by the government’s no encampment policy that led to self-settled practices across the country. This approach helped in understanding the challenging dynamic created by weak public institutions and their failure to guarantee the observance of basic human rights, compromising displaced Syrians safety. The weakness of public institutions and their failure to guarantee the observance of basic human rights has compromised displaced safety. Moreover, even though the development interventions and aid assistance have been necessary for Syrians' survival, they proved insufficient, and unequally distributed by location evidencing the inefficiencies of the majority of development aid projects. Conclusions The findings contribute to an enriched understanding of the situation of Syrians in Lebanon and offer insights for policymakers, practitioners, and researchers working in the field of forced migration and humanitarian responses.

Osteoarthritis (OA) is the most common form of arthritis, characterized by osteophyte formation, cartilage degradation, and structural and cellular alterations of the synovial membrane. Activated fibroblast-like synoviocytes (FLS) of the synovial membrane have been identified as key drivers, secreting humoral mediators that maintain inflammatory processes, proteases that cause cartilage and bone destruction, and factors that drive fibrotic processes. In normal tissue repair, fibrotic processes are terminated after the damage has been repaired. In fibrosis, tissue remodeling and wound healing are exaggerated and prolonged. Various stressors, including aging, joint instability, and inflammation, lead to structural damage of the joint and micro lesions within the synovial tissue. One result is the reduced production of synovial fluid (lubricants), which reduces the lubricity of the cartilage areas, leading to cartilage damage. In the synovial tissue, a wound-healing cascade is initiated by activating macrophages, Th2 cells, and FLS. The latter can be divided into two major populations. The destructive thymocyte differentiation antigen (THY)1─ phenotype is restricted to the synovial lining layer. In contrast, the THY1+ phenotype of the sublining layer is classified as an invasive one with immune effector function driving synovitis. The exact mechanisms involved in the transition of fibroblasts into a myofibroblast-like phenotype that drives fibrosis remain unclear. The review provides an overview of the phenotypes and spatial distribution of FLS in the synovial membrane of OA, describes the mechanisms of fibroblast into myofibroblast activation, and the metabolic alterations of myofibroblast-like cells.

Objective: Head and trunk control is essential for enhancing engagement and participation by improving visual integration, respiration, oromotor skill, arm control, and self-care. Our study protocol aims to investigate the effect of novel Head And Trunk Control Rehabilitation (HATCoRe) device on promoting head and trunk control in children with Cerebral Palsy (CP). Method: This single subject multiple baseline design trial will include six children with CP aged two to 10 years, exhibiting delayed head and trunk control, having Gross Motor Function Classification System level IV and V will be enrolled. Participants will be randomly assigned to 4-, 6-, or 8-weeks baseline phases followed by 16-week intervention phase with HATCoRe device, for 30–45 min thrice weekly; and follow-up phase of 9 weeks. The study will span for 29 to 33 weeks. An experienced pediatric physiotherapist, blinded to the baseline duration, will assess the outcome measures through 15 to 19 observations. Structured visual analysis will be used supplemented with the celeration line approach to detect statistically significant change. Impact: HATCoRe device can enable health-care professionals to objectively measure head movement trajectories in children with CP. If proven effective, clinicians may utilize this device to create interactive and child engaging sessions.