Regionalizing healthcare: a vision for transforming Lebanon into a regional academic hub

<p>Abstract</p> <p>Background</p> <p>Lebanon suffers from a large scale emigration of physicians coupled with an oversaturation of the physician job market. Lebanon is currently witnessing an expansion of its medical education capacity with the establishment of new private medical schools, raising the fears of a worsening market oversaturation.</p> <p>Discussion</p> <p>The neighboring Arabian Gulf countries are suffering from a serious shortage of clinicians and academicians. In spite of their enormous investments in educational, clinical and research collaborative initiatives with some of the most renowned North American medical schools and institutions, their ability to recruit and retain highly qualified clinicians and academicians remains a major challenge. Lebanese universities have the opportunity to establish triangular collaborations with the Gulf regional medical centers and their North American partners. They could achieve this goal by tapping into the globalized and high quality Lebanese physician workforce and consequently regionalize healthcare delivery in the Middle East.</p> <p>Summary</p> <p>By recruiting its globalized and high quality physician workforce to establish collaborations with the Gulf regional, Lebanon could become a regional "academic hub".</p

Tutorial on LTE/LTE-A Cellular Network Dimensioning Using Iterative Statistical Analysis

LTE is the fastest growing cellular technology and is expected to increase its footprint in the coming years, as well as progress toward LTE-A. The race among operators to deliver the expected quality of experience to their users is tight and demands sophisticated skills in network planning. Radio network dimensioning (RND) is an essential step in the process of network planning and has been used as a fast, but indicative, approximation of radio site count. RND is a prerequisite to the lengthy process of thorough planning. Moreover, results from RND are used by players in the industry to estimate preplanning costs of deploying and running a network; thus, RND is, as well, a key tool in cellular business modelling. In this work, we present a tutorial on radio network dimensioning, focused on LTE/LTE-A, using an iterative approach to find a balanced design that mediates among the three design requirements: coverage, capacity, and quality. This approach uses a statistical link budget analysis methodology, which jointly accounts for small and large scale fading in the channel, as well as loading due to traffic demand, in the interference calculation. A complete RND manual is thus presented, which is of key importance to operators deploying or upgrading LTE/LTE-A networks for two reasons. It is purely analytical, hence it enables fast results, a prime factor in the race undertaken. Moreover, it captures essential variables affecting network dimensions and manages conflicting targets to ensure user quality of experience, another major criterion in the competition. The described approach is compared to the traditional RND using a commercial LTE network planning tool. The outcome further dismisses the traditional RND for LTE due to unjustified increase in number of radio sites and related cost, and motivates further research in developing more effective and novel RND procedures

An educational game for teaching clinical practice guidelines to Internal Medicine residents: development, feasibility and acceptability

<p>Abstract</p> <p>Background</p> <p>Adherence to Clinical Practice Guidelines (CPGs) remains suboptimal among internal medicine trainees. Educational games are of growing interest and have the potential to improve adherence to CPGs. The objectives of this study were to develop an educational game to teach CPGs in Internal Medicine residency programs and to evaluate its feasibility and acceptability.</p> <p>Methods</p> <p>We developed the Guide-O-Game^©in the format of a TV game show with questions based on recommendations of CPGs. The development of the Guide-O-Game^©consisted of the creation of a multimedia interactive tool, the development of recommendation-based questions, and the definition of the game's rules. We evaluated its feasibility through pilot testing and its acceptability through a qualitative process.</p> <p>Results</p> <p>The multimedia interactive tool uses a Macromedia Flash web application and consists of a manager interface and a user interface. The user interface allows the choice of two game styles. We created so far 16 sets of questions relating to 9 CPGs. The pilot testing proved that the game was feasible. The qualitative evaluation showed that residents considered the game to be acceptable.</p> <p>Conclusion</p> <p>We developed an educational game to teach CPGs to Internal Medicine residents that is both feasible and acceptable. Future work should evaluate its impact on educational outcomes.</p

Wireless monitoring of liver hemodynamics in vivo

Liver transplants have their highest technical failure rate in the first two weeks following surgery. Currently, there are limited devices for continuous, real-time monitoring of the graft. In this work, a three wavelengths system is presented that combines near-infrared spectroscopy and photoplethysmography with a processing method that can uniquely measure and separate the venous and arterial oxygen contributions. This strategy allows for the quantification of tissue oxygen consumption used to study hepatic metabolic activity and to relate it to tissue stress. The sensor is battery operated and communicates wirelessly with a data acquisition computer which provides the possibility of implantation provided sufficient miniaturization. In two in vivo porcine studies, the sensor tracked perfusion changes in hepatic tissue during vascular occlusions with a root mean square error (RMSE) of 0.135 mL/min/g of tissue. We show the possibility of using the pulsatile wave to measure the arterial oxygen saturation similar to pulse oximetry. The signal is also used to extract the venous oxygen saturation from the direct current (DC) levels. Arterial and venous oxygen saturation changes were measured with an RMSE of 2.19% and 1.39% respectively when no vascular occlusions were induced. This error increased to 2.82% and 3.83% when vascular occlusions were induced during hypoxia. These errors are similar to the resolution of a commercial oximetry catheter used as a reference. This work is the first realization of a wireless optical sensor for continuous monitoring of hepatic hemodynamics. © 2014 Akl et al

On the Use of Key Assignment Schemes in Authentication Protocols

Key Assignment Schemes (KASs) have been extensively studied in the context of cryptographically-enforced access control, where derived keys are used to decrypt protected resources. In this paper, we explore the use of KASs in entity authentication protocols, where we use derived keys to encrypt challenges. This novel use of KASs permits the efficient authentication of an entity in accordance with an authentication policy by associating entities with security labels representing specific services. Cryptographic keys are associated with each security label and demonstrating knowledge of an appropriate key is used as the basis for authentication. Thus, by controlling the distribution of such keys, restrictions may be efficiently placed upon the circumstances under which an entity may be authenticated and the services to which they may gain access. In this work, we explore how both standardized protocols and novel constructions may be developed to authenticate entities as members of a group associated to a particular security label, whilst protecting the long-term secrets in the system. We also see that such constructions may allow for authentication whilst preserving anonymity, and that by including a trusted third party we can achieve the authentication of individual identities and authentication based on timestamps without the need for synchronized clocks

A well-separated pairs decomposition algorithm for k-d trees implemented on multi-core architectures

Content from this work may be used under the terms of the Creative Commons Attribution 3.0 licence. Any further distribution of this work must maintain attribution to the author(s) and the title of the work, journal citation and DOI.Variations of k-d trees represent a fundamental data structure used in Computational Geometry with numerous applications in science. For example particle track tting in the software of the LHC experiments, and in simulations of N-body systems in the study of dynamics of interacting galaxies, particle beam physics, and molecular dynamics in biochemistry. The many-body tree methods devised by Barnes and Hutt in the 1980s and the Fast Multipole Method introduced in 1987 by Greengard and Rokhlin use variants of k-d trees to reduce the computation time upper bounds to O(n log n) and even O(n) from O(n2). We present an algorithm that uses the principle of well-separated pairs decomposition to always produce compressed trees in O(n log n) work. We present and evaluate parallel implementations for the algorithm that can take advantage of multi-core architectures.The Science and Technology Facilities Council, UK

Progressive loss of CD3 expression after HTLV-I infection results from chromatin remodeling affecting all the CD3 genes and persists despite early viral genes silencing

BACKGROUND: HTLV-I infected CD4+ T-cells lines usually progress towards a CD3- or CD3low phenotype. In this paper, we studied expression, kinetics, chromatin remodeling of the CD3 gene at different time-points post HTLV-I infection. RESULTS: The onset of this phenomenon coincided with a decrease of CD3gamma followed by the subsequent progressive reduction in CD3delta, then CD3epsilon and CD3zeta mRNA. Transient transfection experiments showed that the CD3gamma promoter was still active in CD3- HTLV-I infected cells demonstrating that adequate amounts of the required transcription factors were available. We next looked at whether epigenetic mechanisms could be responsible for this progressive decrease in CD3 expression using DNase I hypersensitivity (DHS) experiments examining the CD3gamma and CD3delta promoters and the CD3delta enhancer. In uninfected and cells immediately post-infection all three DHS sites were open, then the CD3gamma promoter became non accessible, and this was followed by a sequential closure of all the DHS sites corresponding to all three transcriptional control regions. Furthermore, a continuous decrease of in vivo bound transcription initiation factors to the CD3gamma promoter was observed after silencing of the viral genome. Coincidently, cells with a lower expression of CD3 grew more rapidly. CONCLUSION: We conclude that HTLV-I infection initiates a process leading to a complete loss of CD3 membrane expression by an epigenetic mechanism which continues along time, despite an early silencing of the viral genome. Whether CD3 progressive loss is an epiphenomenon or a causal event in the process of eventual malignant transformation remains to be investigated.Journal ArticleResearch Support, Non-U.S. Gov'tinfo:eu-repo/semantics/publishe

Meta-analysis of antibiotics versus appendicectomy for non-perforated acute appendicitis

Background: For more than a century, appendicectomy has been the treatment of choice for appendicitis. Recent trials have challenged this view. This study assessed the benefits and harms of antibiotic therapy compared with appendicectomy in patients with non-perforated appendicitis. Methods: A comprehensive search was conducted for randomized trials comparing antibiotic therapy with appendicectomy in patients with non-perforated appendicitis. Key outcomes were analysed using random-effects meta-analysis, and the quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results: Five studies including 1116 patients reported major complications in 25 (4.9 per cent) of 510 patients in the antibiotic and 41 (8.4 per cent) of 489 in the appendicectomy group: risk difference -2.6 (95 per cent c.i. -6.3 to 1.1) per cent (low-quality evidence). Minor complications occurred in 11 (2.2 per cent) of 510 and 61 (12.5 per cent) of 489 patients respectively: risk difference -7.2 (-18.1 to 3.8) per cent (very low-quality evidence). Of 550 patients in the antibiotic group, 47 underwent appendicectomy within 1 month: pooled estimate 8.2 (95 per cent c.i. 5.2 to 11.8) per cent (high-quality evidence). Within 1 year, appendicitis recurred in 114 of 510 patients in the antibiotic group: pooled estimate 22.6 (15.6 to 30.4) per cent (high-quality evidence). For every 100 patients with non-perforated appendicitis, initial antibiotic therapy compared with prompt appendicectomy may result in 92 fewer patients receiving surgery within the first month, and 23 more experiencing recurrent appendicitis within the first year. Conclusion: The choice of medical versus surgical management in patients with clearly uncomplicated appendicitis is value-and preference-dependent, suggesting a change in practice towards shared decision-making is necessary.Peer reviewe

Surveys of potato-growing areas and surface water in Lebanon for potato brown and ring rot pathogens.

Field surveys were carried out over three growing seasons (2013\u20132015), in the main potato growing areas of Lebanon, to assess the occurrence of potato brown rot caused by Ralstonia solanacearum and potato ring rot caused by Clavibacter michiganensis subsp. sepedonicus. A total of 232 potato samples were collected from Bekaa valley and 145 samples from Akkar plain, which are the largest Lebanese areas cropped with potatoes. Composite samples of 200 potato tubers were randomly collected from each field, following procedures laid down in EU legislation. Twelve potato demonstration fields were established in Akkar plain and designed for potato export to European markets: these were also surveyed using the same strategy. Furthermore, a network of 40 sampling sites in Bekaa and 19 sites in Akkar was established to collect surface water. GPS coordinates of potato fields and water sampling sites were recorded to map specific sampling points using Geographic Information System. All samples gave negative results for R. solanacearum and C. michiganensis subsp. sepedonicus in potatoes and R. solanacearum in water, as indicated using the official EU methods for detection and diagnosis for these pathogens. A monitoring system for R. solanacearum and C. michiganensis subsp. michiganensis has been set up in Lebanon. This will increase the phytosanitary quality of potatoes and provide access to broader international markets