PREVALENCE OF ESBL-PRODUCING ENTEROBACTERIACEAE AMONG LEBANESE PATIENTS WITH URINARY TRACT INFECTIONS

Being the most common infections worldwide, Urinary Tract Infections (UTIs) represent a major public health problem. Gram negative bacteria are the main pathogens causing UTIs where Extended spectrum β–lactamase (ESBL)-Producing Enterobacteriaceae, mainly the multi-drug resistant species, such as E. coli sequence type 131 and klebsiella.pneumoniae, account for serious health problems and high economic burden. In Lebanon, data about prevalence of antibiotic resistant pathogens during UTIs are still scarce. In this study we examined the prevalence of ESBL-producing pathogens among Lebanese patients mainly located at Bekaa governorate. This retrospective study included 7241 urine tests that were collected from all the out- and in-patients, presented to Rayak Hospital from 1-1-2019 till 31-12-2019. Among the 7241 urine tests performed, 7.54% were positive. Among the positive samples, 59%, 17.5% and 1% were caused by E. coli, Klebsiella and Proteus, respectively. Other infections (22%) were caused by other types of pathogens. Among the E. coli-positive samples, Klebsiella-positive samples and Proteus-positive samples 45%, 26% and 17% were ESBL producing, respectively. The ESBL- producing pathogens corresponded to 31% of the total positive UTIs. The distribution of these infection-causing pathogens according to age, gender and hospitality condition was also determined. This study shows for the first time the frequency and distribution of ESBL-producing pathogens among Lebanese UTI-patients in Bekaa region

Corruption Drives the Emergence of Civil Society

Peer punishment of free-riders (defectors) is a key mechanism for promoting cooperation in society. However, it is highly unstable since some cooperators may contribute to a common project but refuse to punish defectors. Centralized sanctioning institutions (for example, tax-funded police and criminal courts) can solve this problem by punishing both defectors and cooperators who refuse to punish. These institutions have been shown to emerge naturally through social learning and then displace all other forms of punishment, including peer punishment. However, this result provokes a number of questions. If centralized sanctioning is so successful, then why do many highly authoritarian states suffer from low levels of cooperation? Why do states with high levels of public good provision tend to rely more on citizen-driven peer punishment? And what happens if centralized institutions can be circumvented by individual acts of bribery? Here, we consider how corruption influences the evolution of cooperation and punishment. Our model shows that the effectiveness of centralized punishment in promoting cooperation breaks down when some actors in the model are allowed to bribe centralized authorities. Counterintuitively, increasing the sanctioning power of the central institution makes things even worse, since this prevents peer punishers from playing a role in maintaining cooperation. As a result, a weaker centralized authority is actually more effective because it allows peer punishment to restore cooperation in the presence of corruption. Our results provide an evolutionary rationale for why public goods provision rarely flourishes in polities that rely only on strong centralized institutions. Instead, cooperation requires both decentralized and centralized enforcement. These results help to explain why citizen participation is a fundamental necessity for policing the commons.Comment: 24 pages, 7 figures (Press embargo in place until publication

Nustar observation of the binary system 4U 0114+65

The high mass X-ray binary system 4U 0114+65 was observed by Nustar in October 2019, and by XMM-Newton in August 2015. Here we performed spectral and timing analysis of the Nustar observation, and carry out timing analysis on the XMM-Newton data. We measured the spin period of the neutron star from both observations and found a spin-up rate $\dot{p} = 1.54 \pm 0.38 \times 10^{-6} s s^{-1}$. During the Nustar observation two flares occured, one occured shortly after the start of the observation and the other near the end separated by a long period of low/quiescent- state. The large and sudden flares mostly resulted from accretion of Corotating Interaction Region (CIR) material. A common spectral model to HMXBs, powerlaw with high energy cutoff and absorption at low energy, gave a good fit to both flaring and quiescent states. A flourescent iron line was not required in fitting any of the states. On the other hand, very tentative evidence of Cyclotron Resonant Scattering Feature (CRSF) at $\sim$ 17 keV was found during fitting using cyclabs model, however fitting improvement was not significant enough to confirm its detection, plus a very narrow width (< 1 keV) was obtained for the line and its first harmonic. Visual inspection of the spectra showed a deficiency of emission near the expected first and second harmonic. Another important feature visually noticed in the spectra is the presence of hard tail above 50 keV. This could be explained by the shocked material bounding the CIR

Enhanced Convolutional Neural Network for Non-Small Cell Lung Cancer Classification

Lung cancer is a common type of cancer that causes death if not detectedearly enough. Doctors use computed tomography (CT) images to diagnoselung cancer. The accuracy of the diagnosis relies highly on the doctor\u27sexpertise. Recently, clinical decision support systems based on deep learningvaluable recommendations to doctors in their diagnoses. In this paper, wepresent several deep learning models to detect non-small cell lung cancer inCT images and differentiate its main subtypes namely adenocarcinoma,large cell carcinoma, and squamous cell carcinoma. We adopted standardconvolutional neural networks (CNN), visual geometry group-16 (VGG16),and VGG19. Besides, we introduce a variant of the CNN that is augmentedwith convolutional block attention modules (CBAM). CBAM aims to extractinformative features by combining cross-channel and spatial information.We also propose variants of VGG16 and VGG19 that utilize a supportvector machine (SVM) at the classification layer instead of SoftMax. Wevalidated all models in this study through extensive experiments on a CTlung cancer dataset. Experimental results show that supplementing CNNwith CBAM leads to consistent improvements over vanilla CNN. Resultsalso show that the VGG variants that use the SVM classifier outperform theoriginal VGGs by a significant margin

Aktivitets- og redegjørelsesplikten i Agder – Hva er status og hvor går veien videre?

NORCE Norwegian Research Centre og Universitetet i Agder (UiA) ved Senter for likestilling (SL), har samarbeidet om denne kartleggingen. SL ønsket en status av likestillingsredegjørelsene i Agder for 2021, og innspill til hvordan man videre kan arbeide med å øke fokuset og aktivitetene rettet mot likestilling, inkludering og mangfold i virksomhetene i Agder for på den måten å bedre likestillingen i vår region. Senteret ønsker å innhente kunnskap som kan brukes til opplæring, veiledning og kompetanseheving i regionen, med vekt på gode eksempler og suksessfaktorer i ARParbeidet. Regionplan Agder 2030 har som ett av sine hovedmål å bidra til bedrede levekår i befolkningen. Likestilling spiller inn på individers og familiers levekår og er derfor et viktig premiss for å oppnå nettopp dette. Oppdraget kommer på bakgrunn av at alle arbeidsgivere i Norge etter likestillings- og diskrimineringsloven har plikt til å jobbe aktivt, målrettet og planmessig for å skape mer likestilling og hindre diskriminering på arbeidsplassen. Fra 1. januar 2020 ble loven skjerpet, både i bestemmelsene om aktivt likestillingsarbeid og plikten til å redegjøre for dette arbeidet. Etter likestillings- og diskrimineringsloven § 24 har hele offentlig sektor en plikt til å jobbe aktivt, målrettet og planmessig for å fremme likestilling og hindre diskriminering i all sin virksomhet. Denne plikten omtales som likestillingsplikten for offentlig sektor, eller bare LOS-plikten. I vår rapport ser vi utelukkende på aktivitets og redegjørelsesplikten for arbeidsgivere, (ARP) og ikke LOS-plikten som retter seg mot offentlig sektors utadrettede virksomhet. Vi redegjør mer for ARP i neste avsnitt. SL har finansiert denne studien og har i tillegg lagt inn betydelig egeninnsats for at vi, tross begrensede økonomiske rammer, kunne kartlegge og dokumentere dette arbeidet i denne rapporten.publishedVersio

Assessment of health-related quality of life in patients receiving stem cell therapy for end-stage liver disease: an Egyptian study

INTRODUCTION: This prospective cohort study aimed to assess the influence of stem cell therapy (SCT) on health-related quality of life (HRQOL) by using the SF-36 v2 and to elucidate the influence of objective clinical variables on subjective HRQOL. METHODS: The study included 100 chronic liver disease patients (50 received SCT, and 50 received supportive medical treatment (SMT)). Both groups completed a modified SF-36 v2 form before therapy and at 1-, 3-, 6-, and 12-month intervals. Fifty healthy Egyptian volunteers were enrolled in the study and completed the SF-36 v2 form once. RESULTS: Both SCT and SMT groups showed significantly lower pretherapy SF 36 v2 scores compared with healthy volunteers. In SCT-treated patients, limited complications were encountered (SF-36 v2 scores showed significant improvement in all domains throughout the follow-up period) compared with the deterioration shown by SMT patients after therapy. A significant association was detected between SF-36 v2 scores and laboratory data in SCT patients during the first month after therapy. The grade of ascites improved during the follow-up in SCT compared with SMT patients. The mean survival time was 277.56 days (95% CI, 246.217 to 308.903) for SMT and 359.300 days (95% CI, 353.022 to 365.578) for SCT patients (log rank, 0.00). Stem cell-treated patients showed no malignancies. CONCLUSIONS: SCT positively affects health-related quality of life in cirrhosis patients. The survival rate was significantly improved after SCT

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

The American and British Press coverage of Refoms in Saudi Arabia and the Personality of Crown Prince Mohammed Bin Salman. (The Washigton Post and The Guardian as Examples)

Aquest estudi té com a objectiu donar llum sobre la cobertura dels mitjans occidentals de les reformes al Regne de l'Aràbia Saudita i la personalitat del príncep hereu Mohammad Bin Salman, que va provocar canvis radicals en la societat saudita, particularment en termes dels drets de les dones saudites i la concessió de privilegis a la societat dels quals van ser privada, com ara sales de cinema i música en llocs públics. Els diaris American Washington Post i The British Guardian van ser escollits com a mostra per a aquest estudi en el període comprès entre gener de 2016 i juny de 2019, és a dir, divuit mesos abans que Bin Salman assumís el càrrec de príncep hereu, i dos anys després d'assumir el càrrec el juny de 2017. La mostra seleccionada va ser escollida segons les tres hipòtesis de l'estudi, és a dir, que l'interès dels mitjans occidentals en els assumptes saudites va augmentar després que Bin Salman prengués possessió del càrrec, hi va haver un canvi en el to del tractament de les notícies entre l'inici del seu regnat d'una banda i després de l'assassinat del periodista saudita Jamal Khashoggi al consolat del seu país a Istanbul, de l'altra, i que hi havia una bretxa professional entre els mitjans de comunicació occidentals i els mitjans de comunicació saudites en el tractament de les reformes a l'Aràbia Saudita i la personalitat de Mohammad Bin Salman. Per aquest motiu, hi havia una mostra del diari saudita Asharq Al-Awsat, des de juny de 2017 fins a juny de 2019, amb l'objectiu d'analitzar la cobertura professional de qüestions com la detenció de prínceps saudites per part de Bin Salman a l'Hotel Ritz-Carlton de Riad, la guerra de l'Aràbia Saudita al Iemen i la imposició d'un bloqueig a Qatar. Això demostra la manca d'objectivitat i incompliment del diari saudita Asharq Al-Awsat amb els principis professionals esperats per la premsa, adoptant així la posició oficial-saudita sobre aquestes qüestions. La mostra estudiada va demostrar la validesa de les tres hipòtesis de l'estudi mitjançant la metodologia d'anàlisi de continguts. També va respondre a les preguntes de l'estudi, incloent la independència de la cobertura dels mitjans de comunicació en els tres diaris des de la posició oficial dels països que allotgen aquests diaris. L'estudi va utilitzar les teories del Media Frame Analysis i l’Agenda Setting, que mostraven l'ús de marcs com el frame de conflicte, el frame econòmic i el frame episòdic, a més de l’establiment de prioritats en el tractament de les notícies, particularment en el cas Khashoggi, que sempre va arribar a les primeres pàgines en aquests mitjans de comunicació.Este estudio tiene como objetivo arrojar luz sobre la cobertura de las reformas de los medios de comunicación occidentales en el Reino de Arabia Saudita y la personalidad del príncipe heredero Mohammad Bin Salman, quien provocó cambios radicales en la sociedad saudita, particularmente en términos de los derechos de las mujeres sauditas y otorgando a la sociedad privilegios de los que fue privada, como cines y música en lugares públicos. Los periódicos American Washington Post y The British Guardian fueron elegidos como muestra para este estudio en el período comprendido entre enero de 2016 y junio de 2019, es decir, dieciocho meses antes de que Bin Salman asumiera el cargo de Príncipe Heredero, y dos años después de que asumiera el cargo en junio de 2017. La muestra seleccionada fue elegida según las tres hipótesis del estudio, a saber, que el interés de los medios occidentales en los asuntos saudíes aumentó después de que Bin Salman asumió el cargo, hubo un cambio en el tono del tratamiento de las noticias entre el comienzo de su reinado, por un lado, y después del asesinato del periodista saudí Jamal Khashoggi en el consulado de su país en Estambul, por el otro, y que había una brecha profesional entre los medios de comunicación occidentales y los medios saudíes en el tratamiento de las reformas en Arabia Saudita y la personalidad de Mohammad Bin Salman. Por esta razón, hubo una muestra del periódico saudí Asharq Al-Awsat, desde junio de 2017 hasta junio de 2019, con el propósito de analizar la cobertura profesional de temas como la detención de príncipes saudíes por parte de Bin Salman en el Hotel Ritz-Carlton de Riad, La guerra de Arabia Saudita contra Yemen y su imposición de un bloqueo a Qatar. Esto demuestra la falta de objetividad y el incumplimiento de los principios profesionales del periódico saudí Asharq Al-Awsat, adoptando así la posición oficial-saudí sobre estos temas. La muestra estudiada demostró la validez de las tres hipótesis del estudio a través de la metodología de análisis de contenido. También respondió a las preguntas del estudio, incluida la independencia de la cobertura de los medios en los tres periódicos de la posición oficial de los países que albergan estos periódicos. El estudio empleó las teorías del Media Frame Analysis y la Agenda Setting, que mostraron el uso de marcos como el frame de conflicto, el frame económico y el frame episódico, además del establecimiento de prioridades en el tratamiento de noticias, particularmente en el caso Khashoggi, que siempre llegó a las portadas de estos medios de comunicación.This study aims to shed light on the Western media’s handling of reforms in the Kingdom of Saudi Arabia and the personality of Crown Prince Mohammad Bin Salman, who brought about radical changes in the Saudi society, particularly in terms of Saudi women’s rights and granting society privileges of which it was deprived, such as movie theaters and music in public places. The American Washington Post and The British Guardian newspapers were chosen as the sample for this study in the period between January 2016 and June 2019, i.e., eighteen months before Bin Salman assumed the position of Crown Prince, and two years after he assumed office in June 2017. The selected sample was chosen as per the three study hypotheses, namely that Western media’s interest in Saudi affairs increased after Bin Salman took office, there was a change in tone of news handling between the beginning of his reign on the one hand and after the murder of Saudi journalist Jamal Khashoggi in his country’s consulate in Istanbul on the other, and that there was a professional gap between Western media and Saudi media in handling reforms in Saudi Arabia and the personality of Mohammad Bin Salman. For this reason, there was a sample from the Saudi newspaper Asharq Al- Awsat, starting from June 2017 until June 2019 for the purpose of analyzing the professional coverage of issues such as Bin Salman’s detention of Saudi princes in the Ritz-Carlton Hotel in Riyadh, Saudi Arabia’s war on Yemen and its imposition of a blockade on Qatar. This demonstrates the Saudi newspaper Asharq Al- Awsat’s lack of objectivity and non-compliance with professional principles expected from the press, thus adopting the Official-Saudi position on these issues. The studied sample proved the validity of the three hypotheses of the study through the content analysis methodology. It also answered the study questions, including how independent the media coverage was in the three newspapers from the official position of the countries that host these newspapers. The study employed the Media Frame Analysis and Agenda Setting theories which showed the use of media frames such as Conflict Frame, Economic Frame, and Episodic Frame, in addition to setting priorities in handling news, particularly in the Khashoggi case, which always made it to the front pages in these media outlets