The conservation project and archaeological excavation of the old Parish Church at Siggiewi - an intermediate report

Until December 2007 the old parish church of Siggiewi, dating back to the late medieval period, and occupying a central location within the village core, had been in a neglected and dilapidated state for a very long time, so much so that the remaining ruins were almost totally covered with debris and thick vegetation (Plates 2; 9A; 9D; colour plate 2A; Fig. 4 and colour plate 3). While passing by the walled up and highly degraded site, the inhabitants of Siggiewi barely knew that beneath the soil and vegetation were the remains of their first parish church and the cemetery where most of their ancestors had been buried.peer-reviewe

The role-of the legal procurator in the Maltese judicial system

The institution of the Procurato (Procuratori and Sollecitatori approvati) finds its origins prior to the promulgation of the Prammatiche by Grand Masters Lascaris (1640) and Caraffa (1681). In the Leggi e Costituzioni Prammaticali of Grand Master Manoel de Vilhena (promulgated in 1723) a distinction is drawn between the competence of the advocate (giurisperito) and the legal procurator (procuratore or sollecitatore approvato) in requests for the issue of executive warrants. One finds also references to the profession in the Consolata di Mare di Malta promulgated by Grand Master Perellos in 1697.peer-reviewe

Electron Decoupling with Chirped Microwave Pulses for Magic Angle Spinning Dynamic Nuclear Polarization Nuclear Magnetic Resonance Spectroscopy

Dynamic nuclear polarization (DNP) is a method of generating hyperpolarization of nuclear spins for nuclear magnetic resonance (NMR) spectroscopy. Coherent, time domain techniques make the possibility of DNP directly to spins of interest at room temperature and higher feasible in magic angle spinning (MAS) NMR, allowing for optimal experimental repetition times to be limited by the T_1 of the electron, rather than a much longer T_1DNP, with excellent resolution. The strong hyperfine couplings that make such direct DNP transfers possible, however, can lead to short nuclear relaxation times that result in broadening of nuclear resonances and reduce sensitivity. This dissertation describes the implementation of electron decoupling, performed by rapidly chirping the irradiating microwave frequency through the electron resonance frequency of the narrow line Trityl Finland radical. The frequency chirps are produced by modulating the accelerating voltage of a frequency agile gyrotron. The voltage modulation is programed into the spectrometer arbitrary waveform generator using MATLAB. The experiments described here were performed both at a common DNP temperature of 90 K and with the first MAS experiments performed below 6 K. Experiments were performed using both direct polarization of the nuclei from the electrons, and with indirect polarization using cross polarization. Electron decoupling both narrows nuclear resonances and improves their integrated area. A method for performing analytical powder averaging for fast simulations of electron detected MAS DNP experiments is also described, anticipating the incorporation of electron detection into magnetic resonance experiments under ultra-fast MAS for excellent sensitivity. The simulations are performed using a home written PYTHON code

Eradication of an outbreak of vancomycin-resistant Enterococcus (VRE): the cost of a failure in the systematic screening

BACKGROUND: Vancomycin-resistant enterococci (VRE) are still a concern in hospital units tending to seriously ill patients. However, the cost-effectiveness of active surveillance program to identify asymptomatically VRE colonized patient remains debatable. This work aims at evaluating the cost of a failure in the active surveillance of VRE that had resulted in an outbreak in a French University Hospital. FINDINGS: A VRE outbreak was triggered by a failure in the systematic VRE screening in a medico-surgical ward specialised in liver transplantation as a patient was not tested for VRE. This failure was likely caused by the reduction of healthcare resource. The outbreak involved 13 patients. Colonized patients were grouped in a dedicated part of the infectious diseases unit and tended by a dedicated staff. Transmission was halted within two months after discovery of the index case. The direct cost of the outbreak was assessed as the cost of staffing, disposable materials, hygiene procedures, and surveillance cultures. The loss of income from spare isolation beds was computed by difference with the same period in the preceding year. Payments were drawn from the hospital database. The direct cost of the outbreak (2008 Euros) was €60 524 and the loss of income reached €110 915. CONCLUSIONS: Despite this failure, the rapid eradication of the VRE outbreak was a consequence of the rapid isolation of colonized patient. Yet, eradicating even a limited outbreak requires substantial efforts and resources. This underlines that special attention has to be paid to strictly adhere to active surveillance program

Public and pharmacist perceptions towards counterfeit medicine in Lebanon using focus groups

Counterfeit medicine is a product that is deliberately and fraudulentlymislabelled with respect to identity or source. The international concern is the risk counterfeits pose for public health. To date, there are no published studies on public and pharmacist perceptions towards counterfeit medicine in Lebanon. Therefore, the aim of the study was to explore participants’ experiences, views and beliefs regarding counterfeit medicine by employing the mixed methods methodology.Methods: The study used four focus groups. The two public focus groups were recruited using the convenience sampling method from two schools in Mount Lebanon. The two pharmacists’ focus groups were recruited by the snowball approach from different pharmacy settings. All participants were above 18 years old.Results: The public and pharmacist focus groups had a total of 24 and 13 participants respectively. Using thematic analysis, themes and subthemes emerged from the discussions, and the common themes between the public and pharmacists were; awareness, trust, corruption and overcoming counterfeit medicine.Conclusions: The findings showed the perceived risk counterfeit medicine pose to individuals and public health. According to focus group participants, the situation is serious and requires more attention from the Ministry of Public Health and Order of Pharmacists. Therefore, the need is to establish strict control on medicine; implement and enforce the law; reactivate the central laboratory; create a counterfeit medicine reporting system, and develop continuous educational programs

A novel population of activated cytotoxic T cells infiltrate pituitary neuroendocrine tumour subytpes

Non-functional pituitary adenomas (NFPA) are non-hormone secreting pituitary tumours while growth hormone-secreting pituitary adenomas (GHPA) are active pituitary tumours causing acromegaly. Since immunotherapy is becoming the preferred therapeutic strategy in cancers, understanding the diversity of immune cells infiltrating the tumour microenvironment is warranted. However, little is known about the immune landscape of pituitary tumours. We validated an acoustic-assisted hydrodynamic focusing cytometer based method (Attune, Thermofisher) to identify rare immune cell populations in NFPA (n=6) and GHPA (n=3) obtained from patients undergoing transphenoidal surgery. We unravelled key cellular populations of myeloid (macrophages and monocytes) and lymphocytic (CD4 and CD8 T cells) origin using a multi-colour panel of antibodies against cell surface (CD45, CD163, CD64, CD11b, CD3, CD56, CD19, CD4 and CD8) and intracellular (CD68, T-bet, GATA-3 and FOXP3) antigens and assessed the degree of T-cell activation using the CD44 marker. We also checked for the expression of immune checkpoint and exhaustion markers PD1 and TIM-3 respectively. In all samples, lymphocytic infiltrates were detected. In all except 1 NFPA and in all GHPA the CD8:CD4 ratio was greater than 1 ranging from 1.88 - 5.74 in NFPA and 1.35 - 5.21 in GHPA with no statistical difference between NFPA and GHPA. This method also revealed novel populations of activated, cytotoxic T cells in all pituitary adenomas analysed. We are currently characterising the function of these cells in such tumours and how their presence correlates with the patients’ clinical data and tumour characteristics.peer-reviewe

A review of crimes against the administration of justice

The crimes which we will discuss fall into the wide class of offences against the public administration which more particularly impede or interfere with the proper administration of justice. These crimes are dealt with in our code in Sec 99 to 110; the salient offences being: 1. calumnious accusation; 2. simulation of an offence; 3. perjury; 4. retraction; 5. false swearing. In the course of the discussion we will refer to the writings of Italian jurists which have laid the foundations of these sections in our code.peer-reviewe

Understanding misimplementation in U.S. state health departments: An agent-based model

INTRODUCTION: The research goal of this study is to explore why misimplementation occurs in public health agencies and how it can be reduced. Misimplementation is ending effective activities prematurely or continuing ineffective ones, which contributes to wasted resources and suboptimal health outcomes. METHODS: The study team created an agent-based model that represents how information flow, filtered through organizational structure, capacity, culture, and leadership priorities, shapes continuation decisions. This agent-based model used survey data and interviews with state health department personnel across the U.S. between 2014 and 2020; model design and analyses were conducted with substantial input from stakeholders between 2019 and 2021. The model was used experimentally to identify potential approaches for reducing misimplementation. RESULTS: Simulations showed that increasing either organizational evidence-based decision-making capacity or information sharing could reduce misimplementation. Shifting leadership priorities to emphasize effectiveness resulted in the largest reduction, whereas organizational restructuring did not reduce misimplementation. CONCLUSIONS: The model identifies for the first time a specific set of factors and dynamic pathways most likely driving misimplementation and suggests a number of actionable strategies for reducing it. Priorities for training the public health workforce include evidence-based decision making and effective communication. Organizations will also benefit from an intentional shift in leadership decision-making processes. On the basis of this initial, successful application of agent-based model to misimplementation, this work provides a framework for further analyses

Indice de Mannhein en el abdomen agudo perforado en pacientes mayores de 65 años

RESUMEN Se presenta un estudio prospectivo y protocolizado de 98 enfermos mayores de 65 años, operados de urgencia por abdomen agudo perforado, en el Hospital Nacional de Clínicas durante el período comprendido de abril/2007 a abril/2013.El propósito fue determinar la morbi-mortalidad de esta entidad en los ancianos. Los principales afectados fueron mujeres entre 65 y 75 años. Se destaca como principal causa de intervención la afectación del colon en su totalidad. Las complicaciones sépticas y la insuficiencia renal, son los desórdenes que prevalecieron. Aplicación práctica del índice de peritonitis de Mannheim. El abdomen agudo perforado es un cuadro con alta tasa de mortalidad en el adulto mayor. Palabras Claves: Abdomen agudo perforado. Morbi-mortalidad. Índice de peritonitis de Mannheim.  ABSTRACT We present a prospective and protocolizeted study of 98 patients over 65 years, underwent emergency surgery for perforated acute abdomen in the Hospital Nacional de Clínicas during the period from April/2007 to April/2013.The purpose was to determine the morbidity and mortality of this entity in the elderly. Mainly affected were women between 65 and 75 years. The leading cause of intervention was the colonic involvement, in its entirety. Septic complications and renal failure are the disorders that prevailed. Practical application of Mannheim peritonitis index. The perforated acute abdomen is a picture with a high rate of mortality in the elderly. Key words: Perforative Acute abdomen. Morbidity and Mortality. Mannheim peritonitis index    </p