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Abstract Introduction Increasing access to healthcare for expectant mothers is a national goal. In Monastir, Tunisia, some Peripheral Maternity Units (PMUs) required assessment. Our goals were to describe the delivery activities in MUs (maternity units) and to assess whether some of PMUs need to have their activities replaced. Method We analyzed aggregate data of deliveries in Monastir from 2015 to 2020. The gouvernorate’s seven public MUs were included. Only the morning activity was allotted for obstetricians and gynecologists, in RMUs 1 and 2, whereas they were not available in all PMUs. Data was gathered from the reports of the National Perinatal Program. Both the availability of Comprehensive Essential Obstetric Care (CEOC) and Basic Essential Obstetric Care (BEOC) were calculated. Trends were calculated using Joinpoint software. The Annual Percent Change (APC) was calculated. Results The number of births decreased from 2015 to 2020 (APC= -4.3%: 95%CI : -6; -2.4; p = 0.003). The largest significant decreases in APCs of deliveries were reported in PMU 2 (APC = -12.6% (95%CI : -20; -4.4; p = 0.014), in PMU 3 (APC = -29.3% (95%CI : -36.5; -21.4; p = 0.001), and in PMU 4 (APC = -32.9% (95%CI: -49.1; -11.5); p = 0.016). If PMU 3 and 4 were no longer operating as maternity facilities, BEOC and CEOC standards would still be adequat. For accessibility, both PMU 3 and PMU 2 are accessible from PMU 4 and PMU 1, respectively. Conclusions Pregnant women prefer to give birth in obstetric services with ability to perform emergency caesarean at the expense of PMU. Nowadays, it appears that accessibility is less important than the presence of qualified human resources when a pregnant woman choose a maternity hospital.

We investigate the determinants of students' misconduct at university. Using a sample of 310 surveyed students, we find that students are more likely to cheat when they have previous misconduct records, when they perceive academic integrity policy as being poorly enforced, and when they perceive that instructor tolerance toward misconduct incidents is high. Moreover, misconduct behavior tends to increase with students' seniority and the perceived level of course difficulty. Surprisingly, students' motivations toward reading, writing, and learning do not seem to have a valuable impact on the likelihood of their misconduct. Our findings have important policy implications that relate to the university culture of academic integrity, instructors' tolerance vis-à-vis students' misconduct behavior, and the effectiveness of punitive actions.

Topolin cytokinins have emerged as valuable tools in micropropagation. This study investigates the metabolism of meta-topolin riboside (mTR) in three distinct tree species: Handroanthus guayacan and Tabebuia rosea (Bignoniaceae), and Tectona grandis (Lamiaceae). Employing labeled N15 mTR, we unraveled the complex mechanisms underlying cytokinin homeostasis, identifying N9-glucosylation as the principal deactivation pathway. Our findings demonstrate a capacity in T. rosea and H. guayacan to reposition the hydroxyl group on the cytokinin molecule, a previously unexplored metabolic pathway. Notably, this study reveals remarkable interfamilial and interspecies differences in mTR metabolism, challenging established perspectives on the role of callus tissue in cytokinin storage. These insights not only illuminate the metabolic intricacies of mTR, a cytokinin with interesting applications in plant tissue culture, but also enhances our understanding of cytokinin dynamics in plant systems, thereby enriching the scientific discourse on plant physiology and cytokinin biology.

Abstract Introduction Physicians involved in medical errors (MEs) can experience loss of self-esteem and negative psychological experiences. They are called “second victims” of the ME. Aims To i) describe the profile, the types and the severity of MEs, and ii) explore the psychological impact on “second victims” to better understand how they cope. Methods It was a cross sectional retrospective study conducted from March to August 2018. All physicians working at Farhat Hached and Sahloul University hospitals were asked to complete a questionnaire about their possible MEs. The impact of MEs was evaluated using the Impact of Event Scale-Revised (IES-R) (scoring, 0–88) (subscales ranges; intrusion, (0–32); avoidance, (0–32); hyperarousal, (0–24)). The diagnosis of post-traumatic stress disorder (PTSD) was made when the total IES-R score exceeded 33. The coping strategies were evaluated using Ways of Coping Checklist Revised (WCC-R) scale (scoring, problem-focused, (10–40); emotion focused, (9–36); seeking social support, (8–32)). Results Among 393 responders, 268(68.2%) reported MEs. Wrong diagnosis (40.5%), faulty treatment (34.6%), preventive errors (13.5%) and faulty communication (6.4%) were the main frequent types of MEs. The most common related causes of MEs were inexperience (47.3%) and job overload (40.2%). The physicians’ median (range) score of the IES-R was 19(0–69). According to the IES-R score, the most frequent psychological impacts were median (range): intrusion, 7(0–28) and avoidance symptoms, 7(0–24). PTSD symptoms affected 23.5% of physicians. Female sex and serious MEs were identified as predictors of PTSD. On the WCC-R check list, coping was balanced between the three coping strategies median (range), problem focused, 28.5(10–40); emotion-focused, 24(9–36) and seeking social support 21(8–32). Conclusion There is a relatively high impact of ME within these North-African university hospital physicians. Coping was balanced within different three strategies as reported worldwide. Physicians adopted more likely constructive changes than defensive ones.

Abstract A fast laser pulse with a q-deformed hyperbolic function shape is investigated in a Multi-level atomic system. Therefore, we first derive the exact solution of the Bloch equations describing a two-level atom excited by a q-deformed laser pulse with dephasing and time-dependent detuning. Next, we analyze the dynamic of the atomic population inversion at resonance and off-resonance of a Rubidium 87 three-level atom driven by a classical weak field and a strong q-deformed control laser. Finally, in order to get a deeper insight of the probe field’s absorption and dispersion properties, we investigate the coherence’s dependence on the q-deformation. Our work demonstrates that, the dynamic of the atomic system can be fully controlled through the manipulation of the asymmetry scaling parameter q of the q-deformed hyperbolic laser wave-form.

An important factor affecting the uniformity of in vitro cultures is the topophysical position of the original explant. We investigated this phenomenon in Handroanthus guayacan, a tropical woody tree species. Shoots from a stock culture were separated into upper, middle and basal sections and transferred to a modified MS medium containing meta-topolin-riboside and indole-butyric acid. After 8 weeks, the middle section produced the most shoots, the longest shoots and the highest number of nodes per plant. Shoots derived from the upper section were elongated, but had the shortest internodes, while those from the basal section formed the largest callus. None of the three types of explants rooted during the proliferation phase. The topophysically dependent spatial distribution of endogenous cytokinins and auxins was determined. The topophysical effect observed could not be explained solely by analyzing the endogenous isoprenoid and auxin. However, the metabolism and distribution of the aromatic cytokinin could provide an explanation. The concentration of the meta hydroxy-substituted topolins was highest in shoots derived from the middle section. Aromatic N- and O-glucosides were much more concentrated in the leaves than in the stems. In conclusion, it is recommended to consider the explant’s topophysis when developing a multiplication protocol to avoid heterogeneity in an in vitro culture.

Abstract Background Sexually Transmitted Infections (STIs) are a public health problem, especially for reproductive-age women. The aim of this study was to determine the incidence and trend of STIs during 11 years in Tunisia (2007–17). Methods We conducted a descriptive study including all women with curable STIs (chlamydia, gonorrhea, syphilis and trichomoniasis) diagnosed with the syndromic approach in all basic health care centers of the Governorate of Monastir (Tunisia) from 2007 to 2017. Syndromes included, Pelvic Pain (PP), Vaginal Discharge (VD) and Genital Ulceration (GU). Results We analyzed 40,388 episodes of curable STIs with a crude incidence rate and age standardized incidence rate of 1393 (95% Confidence Interval (CI); 1348–1438) / 100,000 Person Year (PY) and 1328 (95%CI; 1284–1372) /100,000 PY respectively. The incidence rate showed a positive trend over 11 years for all age groups and syndromes. VD was the most common syndrome with a crude incidence rate of 1170/100,000 PY. For all syndromes, women aged 20 to 39 were the most affected age group (p

Healthcare workers have potentially been among the most exposed to SARS-CoV-2 infection as well as the deleterious toll of the pandemic. This study has the objective to differentiate the pandemic toll from post-acute sequelae of SARS-CoV-2 infection in healthcare workers compared to the general population.The study was conducted between April and July 2021 at the Geneva University Hospitals, Switzerland. Eligible participants were all tested staff, and outpatient individuals tested for SARS-CoV-2 at the same hospital. The primary outcome was the prevalence of symptoms in healthcare workers compared to the general population, with measures of COVID-related symptoms and functional impairment, using prevalence estimates and multivariable logistic regression models.Healthcare workers (n = 3083) suffered mostly from fatigue (25.5 %), headache (10.0 %), difficulty concentrating (7.9 %), exhaustion/burnout (7.1 %), insomnia (6.2 %), myalgia (6.7 %) and arthralgia (6.3 %). Regardless of SARS-CoV-2 infection, all symptoms were significantly higher in healthcare workers than the general population (n = 3556). SARS-CoV-2 infection in healthcare workers was associated with loss or change in smell, loss or change in taste, palpitations, dyspnea, difficulty concentrating, fatigue, and headache. Functional impairment was more significant in healthcare workers compared to the general population (aOR 2.28; 1.76–2.96), with a positive association with SARS-CoV-2 infection (aOR 3.81; 2.59–5.60).Symptoms and functional impairment in healthcare workers were increased compared to the general population, and potentially related to the pandemic toll as well as post-acute sequelae of SARS-CoV-2 infection. These findings are of concern, considering the essential role of healthcare workers in caring for all patients including and beyond COVID-19.

In this research study, we derive the exact solutions of the Bloch equations describing the dynamics of a two-level atom with dephasing. In the two-level atom, a strong laser pump couples a ground state to an upper excited state with a time-dependent Rabi-frequency. The exact solutions are given for the atomic population inversion and the real and imaginary parts of the coherence while the input pulse is an asymmetric hyperbolic cosine form. Additionally, the system is under a chirped detuning. The method of solving the Bloch equations analytically is a very tedious part of the research, and as far as we know, there are few exact solutions available in this field. Hence, our solutions might be of great interest to various research areas, including nuclear magnetic resonance, where analytical solutions to the Bloch equations play a major role in the study of the information on the state of the medium as determined by the NMR signals.

Purpose The Actionable Register of Geneva Outpatients and inpatients with SARS-CoV-2 (ARGOS) is an ongoing prospective cohort created by the Geneva Directorate of Health. It consists of an operational database compiling all SARS-CoV-2 test results recorded in the Geneva area since late February 2020. This article aims at presenting this comprehensive cohort, in light of some of the varying public health measures in Geneva, Switzerland, since March 2020.Participants As of 1 June 2021, the database included 360 525 patients, among which 65 475 had at least one positive test result for SARS-CoV-2. Among all positive patients, 37.6% were contacted only once, 10.6% had one follow-up call, 8.5% had two and 27.7% had three or more follow-up calls. Participation rate among positive patients is 94%. Data collection is ongoing.Findings to date ARGOS data illustrates the magnitude of COVID-19 pandemic in Geneva, Switzerland, and details a variety of population factors and outcomes. The content of the cohort includes demographic data, comorbidities and risk factors for poor clinical outcome, self-reported COVID-19 symptoms, environmental and socioeconomic factors, prospective and retrospective contact tracing data, travel quarantine data and deaths. The registry has already been used in several publications focusing on symptoms and long COVID-19, infection fatality rate and re-infection.Future plans The data of this large real-world registry provides a valuable resource for various types of research, such as clinical research, epidemiological research or policy assessment as it illustrates the impact of public health policies and overall disease burden of COVID-19.

Introduction: Tooth wear is a multifactorial progressive condition, leading to the loss of dental hard tissues. It is the result of a combination of mechanical (attrition and abrasion) and chemical (erosion) processes. As a consequence of worn dentition, patients claimed functional and esthetic problems. Case description: This case report presents a 43 years-old senior female patient with a severe dental wear. Clinical examination revealed a worn dentition, a conserved vertical dimension and functional and esthetic problems, with a healthy periodontium. An adequate increase of the vertical dimension of occlusion was necessary to harmonize dentofacial esthetics and to provide an adequate space for the restorative material. A full-mouth conservative prosthetic rehabilitation was then conducted. Tabletops were bonded in the posterior region to restore the VDO, ceramic veneers and palatal indirect resin to reestablish the maxillary anterior contact and guidance. Discussion: Rehabilitation of worn dentition still remains a challenging situation for practitioners. In fact, because of its multifactorial etiology, tooth wear can manifest in many ways, and therefore, it can be difficult to diagnose and to manage. Traditionally, a full-mouth rehabilitation based on full-crown coverage has been the recommended treatment for patients with tooth wear. Nowadays, the improvement of adhesive techniques leads to a more conservative approach for such situation. Conclusion: The innovative approach to restore worn dentition using an adhesive technique should be preferred to achieve maximum preservation of the tooth structure and the most predictable esthetic and functional outcome.

Introduction: Large posterior defects located beneath the gingival tissues and probably invading the biological width, complicate the use of indirect bonded restorations during rubber dam isolation, impression taking and adhesive procedures.A minimally invasive technique allows to relocate subgingival margin to supragingival level using a resin composite material. This procedure is known as deep margin elevation. Case Description: A 30-year-old female patient, consulted with a restoration loss on molar. The patient was in a good general health. Clinical examination revealed a large sized cavity, associated with cuspal involvement and recurrent carious lesion, extending below the cemento-enamel junction. The treatment plan included a deep margin elevation, followed by an indirect CAD/CAM Lithium disilicate restoration. Discussion: The deep margin elevation procedure decision was based on the presence of deep class II cavity with proximal cervical margin extending below the cemento-enamel junction, the non-invasion of the connective compartment of the biologic width (caries with a margin in the junctional epithelium) and the ability to get a proper isolation using rubber dam and curved matrix. In this case, a two-step etch-and-rinse adhesive system and a combination of restorative and flowable composites were used. The subgingival composite obturation was well tolerated by surrounding tissues. Conclusion/Clinical Significance: Deep margin elevation is a relatively recent technique which benefits seem recognized. The durability of indirect restorations depends on the respect of a correct protocol and the use of appropriate materials.In this case, a two-step etch-and-rinse adhesive system and a combination of a filled hybrid and flowable composites were used.