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Pediatric colorectal studies have shown enhanced recovery after surgery (ERAS) protocols can safely improve outcomes. This study sought to determine the impact of an ERAS pathway on the outcomes of children with colorectal conditions who underwent colostomy closure or Malone procedure.A single-institution, retrospective cohort study of children who underwent colostomy closure or Malone procedure between 2016 and 2020 was performed. Differences in outcomes between pre-ERAS and ERAS cohorts were tested. A sub-analysis based on procedure type was performed.There were 96 patients included: 22 prior to ERAS implementation and 74 after. Patients who underwent ERAS had shorter mean time (hours) to oral intake, mean days until regular diet, post-operative opioid volume, and median length of stay (p 0.05). There was no difference in complication rates in the ERAS and pre-ERAS cohort (12.2 vs 9.1%, p = 0.99). Patients who underwent colostomy closure after ERAS had lower post-operative opioid use, but no differences were seen in those who underwent Malone.Implementation of an ERAS protocol resulted in quicker time to oral intake, normal diet, and decreased opioid use without increasing complication rates. Differences seen based on procedure type may reflect that the effect of an ERAS protocol is procedure specific.

Packed red blood cell (PRBC) transfusion is a lifesaving intervention that also has proinflammatory and immunosuppressive effects. Adults with a malignancy who receive PRBC transfusion have increased rates of infection, tumor recurrence, and decreased survival. The effect of PRBC transfusion among children with solid tumors is unknown.We performed a retrospective review of all children who underwent operative resection of a solid tumor malignancy. Data collected included demographic information, location of operation, nadir hemoglobin, and any PRBC transfusion within 30 days of tumor resection.Three hundred sixty children underwent tumor resection at our institution between 2002 and 2013; 194 (54%) received a perioperative blood transfusion. After adjusting for stage at diagnosis, tumor location, preoperative chemotherapy and nadir hemoglobin, blood transfusion was associated with a higher rate of postoperative infectious complications, shorter disease-free interval, and a higher rate of tumor recurrence. Each additional transfused unit increased the risk of postoperative infection (odds ratio 3.83; 95% confidence interval 1.21, 14.22, P=0.031).Among children with solid tumor malignancies, PRBC transfusion within 30 days of operation is associated with higher rates of postoperative infection. If transfusion becomes necessary, single unit increments should be transfused.Level III.

Introduction: SARS-CoV2 leads to increased Angiotensin II resulting in worsened cardiovascular disease (CVD) outcome and prognosis. ACEIs and ARBs prescribed drugs could be a crucial player in SARS-COV2 prognosis, owing that ACE2 is one SARS-CoV2 binding site and that ACE2 expression in the cardiovascular system is markedly elevated following the treatment with ACEIs and ARBs. Hypothesis: We hypothesized that hospitalized SARS-COV2 Lebanese patients with varying stages of heart failure (A through C) taking ACEIs or ARBs will exhibit an overall better cardiovascular prognosis than control patients with comparable demographics but on other cardiovascular medications. Method: Lebanese patients (N=66) classified as heart failure A-C and admitted to AUBMC for SARS-CoV2 infection were recruited as a part of an ongoing clinical study. Patients were assigned to the control group (No ACEIs or ARBs) or the study sample group (on ACEIs or ARBs). Baseline characteristics including cardiovascular, inflammatory, respiratory and overall outcomes were collected from the patients’ medical charts and analyzed. Unadjusted associations on recruited patients are presented here. Adjusted analyses will be performed when a total of 200 patients is reached. Results: The average age of patients was 69±12.42. The total average weight was 84.24±15.59 Kg and significantly higher in ACEIs/ARBs group (p=0.032). Most patients were males (48 of 66) and patients on ACEIs/ARBs medication were 38 of 66. Heart failure stage, systolic and diastolic blood pressures and heart rate were comparable on presentation between patients on ACEIs/ARBs and controls. Unadjusted analysis showed a significantly higher percentage of death (p=0.024), mechanical ventilation (p=0.05), and elevated troponin (p=0.03) in the control group. A trend towards higher percentage of elevated NT-ProBNP and high levels of peak IL-6 were observed in the control group (p = 0.088 and p=0.076 respectively). All patients had elevated CRP on admission. SARS-CoV2 treatments were comparable between the two groups. Conclusion: Higher mortality and worsened prognosis were observed in the control groups when compared to the ACEIs/ARBs group. Ongoing recruitment is currently underway to perform adjusted analyses.

Rapid urbanization, closure of dumps, and insufficient infrastructure funding in Lebanon have resulted in improper municipal solid waste management (MSWM), creating a continuing trash crisis in recent years. In Beirut and Mount Lebanon, MSWM was carried out in centralized waste processing and disposal facilities operated by the government. The trash crisis and failure of the centralized system prompted several municipal authorities to decentralize MSWM by establishing local facilities, paid by the council taxes charged to beneficiary households. To study the feasibility of decentralized MSWM, a survey of 228 households in a rural village in Lebanon explored households’ willingness to pay (WTP) for a local MSWM service. For data analysis, a multivariate Tobit model was used to examine the determinants of the WTP amount. Results showed that 79% of surveyed households in the studied village were willing to support local MSWM improvements by contributing an average yearly fee of US$48, representing a 30% increase in their current council taxes. Analysis showed a significant positive association between the WTP amount and the household monthly income level, the residents perceived needs for urgency to act on solid waste management, and the households’ responsibility to be involved in MSWM. An interview with the municipality mayor later revealed that financial, technical, and land resources are lacking to enable consideration of a decentralized project for MSWM in the village. Municipalities in rural areas have limited resources and are unable to sustain a decentralized MSWM service unless adjacent towns join effort in supporting and financing MSWM initiatives.

The agricultural sector in Lebanon relies heavily on agrochemicals for crop protection; thus exposing humans and the environment to the harmful effects of pesticides. This study investigated Lebanese farmers' pesticide use practices and explored the underlying factors associated with farmers' choices. Of the 104 surveyed farmers, around 87% were willing to use pesticides that are less toxic to humans and the environment than those currently using, if available. The majority of these farmers (92%) planted their crops in greenhouses. Willingness to use less toxic pesticides was significantly associated with farmers using greenhouses as opposed to open fields, after adjusting for demographic and behavioural characteristics (OR = 7.50; p = 0.010). There was no association between willingness to use less toxic pesticides and perceptions of pesticides' health effects. Policies banning the import and sale of internationally banned pesticides must be enforced. Farmers must be supported to make informed choices about pesticides and their use.

Screening for anxiety and depression is essential for treatment. Participants aged 30 years and above (n = 290) were screened for anxiety and depression using the HSCL-25-Arabic in Lebanon. Confirmatory factor analysis was used to determine the best fit of the data. Five models were tested: (1) the tripartite model including five correlated factors: two related to anxiety, two to depression and a mixed factor describing general distress, (2) the tripartite model considering no correlation between anxiety and depression, (3) the original two-factor model assuming an association between depression and anxiety; (4) the two-factor model considering no correlation between factors; (5) the bifactor model including anxiety and depression, and a general factor underlying all items assuming no association between the three. The bi-factor model showed the best fit followed by the two-factor model. The HSCL-25-Arabic discerns symptoms of anxiety and depression as distinct with a general factor underlying all items.

Information on the scope of nursing practice is urgently needed in the Eastern Mediterranean region to help policy makers and directors of nursing develop informed workforce plans.This study aimed to validate the Arabic translation and cultural adaptation of the Actual Scope of Practice Questionnaire (A-ASCOP).The process of translation and cultural validation adhered to WHO guidelines. The process involved forward translation, review by an expert panel, back-translation, pre-testing and cognitive interviewing.The clarity, meaningfulness and relevance of the first Arabic version of the A-ASCOP has been validated.Subject to psychometric analysis, the A-ASCOP is suitable for use in Lebanon and countries of the Middle Eastern region.ترجمة وصلاحية التكيُّف الثقافي لاستبيان ”نطاق الممارسة الفعلي“.لينا يونان، مايكل كلينتون، سهى فارس، هيلين سماحة.توجد حاجة ملّحة لجمع معلومات بشأن نطاق ممارسة التمريض في إقليم شرق المتوسط من أجل مساعدة راسمي السياسات ومديري التمريض على وضع خطط مبنية على المعرفة للقوى العاملة.هدفت هذه الدراسة إلى التحقُّق من صحة الترجمة العربية لاستبيان ”نطاق الممارسة الفعلي“ وصلاحية التكيُّف الثقافي.اتبعت عملية التحقُّق من الترجمة والتكييف الثقافي المبادئ التوجيهية لمنظمة الصحة العالمية. وشملت العملية ترجمة النص الأصلي، والمراجعة بواسطة لجنة من الخبراء، والترجمة الارتدادية، والاختبارات المسبقة والمقابلات المعرفية.تم التحقُّق من صلاحية النسخة العربية الأولى من استبيان ”نطاق الممارسة الفعلي“ كما تم التحقُّق من مغزاه وصلته بالموضوع.وفقًا لتحليل القياس النفسي، يُعَدُّ استبيان ”نطاق الممارسة الفعلي“ مناسبًا للاستخدام في لبنان وبلدان إقليم شرق المتوسط.Validité de la traduction et de l’adaptation culturelle du Questionnaire de l’étendue de la pratique infirmière (QÉPI).Des informations sur l’étendue de la pratique infirmière sont requises de toute urgence dans la Région de la Méditerranée orientale afin d’aider les responsables politiques et les directeurs de services infirmiers à mettre au point des prévisions relatives aux effectifs du personnel en toute connaissance de cause.La présente étude avait pour objectif de valider la traduction arabe et l’adaptation culturelle du Questionnaire de l’étendue de la pratique infirmière (QÉPI).Le processus de traduction et de validation culturelle était conforme aux lignes directrices de l’OMS, et impliquait la traduction initiale, la révision par un panel d’experts, la production d’une rétro-traduction, un test préalable du questionnaire et la réalisation d’un entretien cognitif.La clarté, l’importance, et la pertinence de la première version arabe du QÉPI ont été validées.Sous réserve de l’analyse psychométrique, le Questionnaire de l’étendue de la pratique infirmière est adapté à une utilisation au Liban et dans les pays de la région du Moyen-Orient.

Blood pressure (BP) varies on the long, short and very-short term. Owing to the hidden physiological and pathological information present in BP time-series, increasing interest has been given to the study of continuous, beat-to-beat BP variability (BPV) using invasive and noninvasive methods. Different linear and nonlinear parameters of variability are employed in the characterization of BP signals in health and disease. Although linear parameters of beat-to-beat BPV are mainly measures of dispersion, such as standard deviation (SD), nonlinear parameters of BPV quantify the degree of complexity/irregularity- using measures of entropy or self-similarity/correlation. In this review, we summarize the value of linear and nonlinear parameters in reflecting different information about the pathophysiology of changes in beat-to-beat BPV independent of or superior to mean BP. We then provide a comparison of the relative power of linear and nonlinear parameters of beat-to-beat BPV in detecting early and subtle differences in various states. The practical advantage and utility of beat-to-beat BPV monitoring support its incorporation into routine clinical practices.

Cardiac autonomic neuropathy (CAN) is an early cardiovascular manifestation of type 2 diabetes (T2D) that constitutes an independent risk factor for cardiovascular mortality and morbidity. Nevertheless, its underlying pathophysiology remains poorly understood. We recently showed that localized perivascular adipose tissue (PVAT) inflammation underlies the incidence of parasympathetic CAN in prediabetes. Here, we extend our investigation to provide a mechanistic framework for the evolution of autonomic impairment as the metabolic insult worsens. Early metabolic dysfunction was induced in rats fed a mild hypercaloric diet. Two low-dose streptozotocin injections were used to evoke a state of late decompensated T2D. Cardiac autonomic function was assessed by invasive measurement of baroreflex sensitivity using the vasoactive method. Progression into T2D was associated with aggravation of CAN to include both sympathetic and parasympathetic arms. Unlike prediabetic rats, T2D rats showed markers of brainstem neuronal injury and inflammation as well as increased serum levels of IL-1β. Experiments on PC12 cells differentiated into sympathetic-like neurons demonstrated that brainstem injury observed in T2D rats resulted from exposure to possible proinflammatory mediators in rat serum rather than a direct effect of the altered metabolic profile. CAN and the associated cardiovascular damage in T2D only responded to combined treatment with insulin to manage hyperglycemia in addition to a nonhypoglycemic dose of metformin or pioglitazone providing an anti-inflammatory effect, coincident with the effect of these combinations on serum IL-1β. Our present results indicate that CAN worsening upon progression to T2D involves brainstem inflammatory changes likely triggered by systemic inflammation.

Introduction The Nursing Practice Act in Lebanon allows multiple entry points to practice, with blurred scope of practice demarcation lines between registered nurses (RNs) and practical nurses (PNs). Aim To analyze the nursing workforce composition of hospital-based nurses and identify the differences and similarities in their enacted scope of practice. Methods A national cross-sectional descriptive survey of 2,852 nursing staff working in 39 hospitals across Lebanon was conducted to measure nursing composition by degree and reported scope of practice. Results The survey responses revealed that 37% of nurses have academic degrees, 41% have technical degrees, and 22% have practical training (no degree). There were no significant differences in the overall mean scores of nursing activities performed within and between academic and technical degree holders. The actual scope of practice increased with years of experience but not with levels of professional education. Conclusion This study showed that the gaps in the current outdated Lebanese Nursing Practice Act are reflected in the way nurses are deployed and working. Some nurses are practicing beyond the boundaries of their educational preparation, while others are not practicing to their full scope. Major reforms need to be properly planned and supported by all stakeholders.

Background and Purpose: Data were analyzed from a national convenience sample of 3,000 bedside nurses in Lebanon to evaluate the psychometric characteristics of the first Arabic version of the Actual Scope of Nursing Practice (A-ASCOP) questionnaire. Methods: The method used in this study was application of the partial credit model using the multidimensional random coefficients multinomial logit model. Results: A-ASCOP subscales (r= .81–.94) and levels of item complexity (r= .95–.98) were highly correlated. Conclusions: As a 26-item scale, the A-ASCOP has high internal consistency (Cronbach’s α = 0.93). The A-ASCOP subscales have acceptable multidimensional reliability Expected A-Posteriori/Plausible Value ratio (EAP/PV > .80) and are suitable for descriptive surveys. The three A-ASCOP levels of item complexity were not valid for this sample. We report norms for unidimensional Rasch and 0–100 transformed measures by category of participant.

ObjectiveThe purpose of this study is to explore symptoms and the effectiveness of their management in older adult palliative care candidates in Lebanon. The aims of this study were to: (1) determine symptom prevalence in Lebanese older adults who qualify for palliative care; (2) identify the severity and distress of symptoms; (3) identify the prevalence of symptom management and its efficacy; and (4) explore the relationship between overall symptom burden and its correlates.MethodThis study uses an observational cross-sectional design using convenience sampling (N = 203) to recruit older adults qualifying for palliative care from three major medical centers in Lebanon.ResultThe mean age of the sample was 78.61 years. The most prevalent symptoms were lack of energy (93.5%), worrying (83.2%), and pain (71.4%). Psychological symptoms had the highest mean scores, preceded only by the physical symptoms and lack of energy. The most treated symptoms were physical with pain having the highest treatment prevalence (91%). Although psychological symptoms were the most burdensome, they were poorly treated. Multiple regression analysis showed that symptom scores had significant positive associations with financial status, social functioning, and comorbidities; there was a negative association with age.Significance of resultsLack of energy and psychological symptoms were the most prevalent, with the latter having the highest mean total symptom scores. Treatment was poor for psychological symptoms and effective for physical ones. Associations were found between age, comorbidity, financial problems, social functioning, and total physical and psychological mean symptom burden scores. More attention needs to be given to psychological symptoms and their management among older adults receiving palliative care.

The female-male ratio in the prevalence of post-traumatic stress disorder (PTSD) is approximately 2:1. Gender differences in experienced trauma types, PTSD symptom clusters, and PTSD risk factors are unclear. We aimed to address this gap using a cross-sectional design. A sample of 991 civilians (522 women, 469 men) from South Lebanon was randomly selected in 2007, after the 2006 war. Trauma types were grouped into disaster and accident, loss, chronic disease, non-malignant disease, and violence. PTSD symptom clusters involved re-experiencing, avoidance, negative cognitions and mood, and arousal. These were assessed using parts I and IVof the Arabic version of the Harvard Trauma Questionnaire (HTQ). Risk factors were assessed using data from a social support and life events questionnaire in multiple regression models. Females were twice as likely as males to score above PTSD threshold (24.3 vs. 10.4%, p ˂ 0.001). Total scores on all trauma types were similar across genders. Females scored higher on all symptom clusters (p0.001). Social support, social life events, witnessed traumas, and domestic violence significantly were associated with PTSD in both genders. Social support, social life events, witnessed traumas and domestic violence were significantly associated with PTSD in both genders. Conversely, gender difference in experienced traumas was not statistically significant. These findings accentuate the need to re-consider the role of gender in the assessment and treatment of PTSD.

Aim To develop and psychometrically test the Basic and Continuing Education Needs of Nurses Instrument. Background Nurses need to keep updating their knowledge through engaging in continuing education and professional development activities. Continuing education should be based on needs assessment. Methods Items generated were devised from a comprehensive literature review guided by Morrel-Samuels' guidelines. Psychometric analysis was then performed on data from 3632 registered nurses across 74 Lebanese hospitals. Two-factor structures were evaluated: the one-dimensional structure including all items and a six-dimensional structure proposed by the authors. Reliability, exploratory and confirmatory factor analyses were used. Associations between the total knowledge score and nurses' characteristics were assessed using linear regression. Results and discussion The total scale had Cronbach's alpha of 0.93 and the six subscales between 0.74 and 0.82. Exploratory factor analysis on the first randomly drawn sample of the data supported the one-factor structure. Confirmatory factor analysis on the second randomly drawn sample revealed that both structures were acceptable with better fit for the six-dimensional structure. Linear regression showed significant associations between total score and nurses' age, income, education and gender. The tool has satisfactory psychometric properties for registered nurses in Lebanon and demonstrated relevance to the Lebanese context of nursing practice. Conclusion We developed a locally adaptable and psychometrically sound instrument to assess the perceived learning needs of Lebanese nurses. Evidence of the validity and reliability of the instrument was provided. Implications for nursing and health policy At a practice level, the Instrument allows nurse leaders to assess knowledge gaps and respond accordingly to nurses perceived learning needs at the national level thus improving practice and protecting people's health. At a policy level, this study has implications for developing policies, regulations and guidelines in support of nurses' continuing education needs and their professional development.

Background and PurposeInvestigation of the psychometric properties of the Arabic version of the Occupational Fatigue Exhaustion Recovery (A-OFER) subscales.MethodsPartial credit model (PCM) analyses of 2037 Lebanese nurses' responses to the chronic fatigue (CF), acute fatigue (AF), and intershift recovery (IR) subscales.ResultsThe data were a better fit to the three-dimensional Rasch PCM; difference, χ2 = 2199.3, df = 5, p = .01; unidimensional Akaike information criterion (AIC) = 107355; multidimensional AIC = 105166. Rating categories were disordered and there was item dependence among negatively-keyed items. All items were free of subgroup bias. Inter-subscale correlations were contrary to expectations.ConclusionThe CF subscale has sufficient reliability for screening nurses in Lebanon and the Eastern Mediterranean region for low to moderate levels of occupational fatigue. The construct validity of the A-OFER requires further investigation.

Background: Despite making up a big proportion of the world population, older adults received little palliative care services. Moreover, palliative quality of care provided to older adults has been shown to be poor. Adequate clinician communication, familial support, and religious/spiritual support have been identified as main factors in providing good quality of care. The purpose of our study on Lebanese older adult palliative care patients is to assess the quality of palliative care in terms of access to care, patient-clinician relationship, and clinician-clinician communication, assess the degree of spirituality/religiousness of patients and their sense of purpose, to explore patients’ relationships including friendships and social support and to assess the degree of financial hardship during the illness. Methods: An observational cross-sectional design was used in this study of hospitalized older adults in three major medical centers in Lebanon over a period of 2 years from 2015 to 2017. Key physicians from each of the three medical centers recruited participants into the study to obtain a convenience sample (N=203). Quality of care was measured using 20 selected items from the Needs at the End of life Screening Tool (NEST). Results: Patients reported easy access to care expressed by low median item scores ranging from the lowest 1.0 pertaining to lack of a problematic doctor choice to the highest 3.0 for ease of securing a hospital bed. Difficulty expressing their feelings to their healthcare providers had an average median of 5.0 with other items on communication having higher medians. The sample considered themselves to be highly religious or spiritual with a median score of 9.0 and identified an inclination to be more religious or spiritual after their illness with a median of 7.0. Social support was found to be good and financial hardships had low median scores ranging from 3.0 to 5.0. Conclusions: Older adults receiving palliative care reported ease of access to medical care, average communication, good spiritual and social status and minimal financial hardships. The authors recommend integrating spiritual and social aspects into the patients’ palliative care to improve quality of care and quality of life.

COVID-19 has caused worldwide death and economic destruction. The pandemic is the result of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has demonstrated high rates of infectivity leading to great morbidity and mortality in vulnerable populations. At present, scientists are exploring various approaches to curb this pandemic and alleviate its health consequences, while racing to develop a vaccine. A particularly insidious aspect of COVID-19 is the delayed overactivation of the body's immune system that is manifested as the cytokine storm. This unbridled production of pro-inflammatory cytokines and chemokines can directly or indirectly cause massive organ damage and failure. Systemic vascular endothelial inflammation and thrombocytopenia are potential consequences as well. In the case of COVID-19, the cytokine storm often fits the pattern of the macrophage activation syndrome with lymphocytopenia. The basis for the imbalance between the innate and adaptive immune systems is not clearly defined, but highlights the effect of SARS-CoV-2 on macrophages. Here we discuss the potential underlying basis for the impact of SARS-CoV-2 on macrophages, both direct and indirect, and potential therapeutic targets. These include granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin 6 (IL-6), interferons, and CXCL10 (IP-10). Various biopharmaceuticals are being repurposed to target the cytokine storm in COVID-19 patients. In addition, we discuss the rationale for activating the macrophage alpha 7 nicotinic receptors as a therapeutic target. A better understanding of the molecular consequences of SARS-CoV-2 infection of macrophages could lead to novel and more effective treatments for COVID-19.

Cardiac autonomic neuropathy (CAN) occurs early in the course of diabetes leading to significant cardiovascular mortality and morbidity. Manifested as impaired heart rate variability (HRV) and baroreflex sensitivity (BRS), CAN represents an independent risk predictor of cardiac mortality. CAN development is linked to hyperglycemia; however, current understanding extends cardiovascular risk to pre-diabetic patients with slight glycemic changes. Here, we assessed the incidence and manifestation of CAN in a rat model of metabolic challenge prior to and after the development of diabetes. Rats were fed a hypercaloric (HC) diet (4.035 KCal/g vs. 3 KCal/g for control rats) composed of: weight (calories) 18.06 % fat (38.68%), 15.8% protein (15.66%), and 46.13% carbohydrates (45.73%). Stable fasting hyperglycemia developed by 16 weeks of feeding. The pre-diabetic stage was associated with signs of perivascular and epicardiac adipose inflammation (4- and 40- fold increase in IL-1β and TGF-β and 2-fold increase in NK-κB expression; and macrophage infiltration) and increased brainstem oxidative stress accompanied with impairment of HRV (total power decrease from 3098 ± 233 to 89 ± 88μs 2 ) and the parasympathetic arm of the baroreflex (slope decrease from -1.02 ± 0.12 to -0.34 ± 0.04). These abnormalities were reversed upon treatment with non-hypoglycemic doses of either metformin or pioglitazone or upon lowering the rat caloric intake. On the other hand, after progression to diabetes, the autonomic deficit progressed to the sympathetic arm of the baroreflex (Slope reduction from -0.35 ± 0.02 to -0.09 ± 0.03). The same hypoglycemic doses of metformin and pioglitazone failed to reverse the impaired HRV and BRS. Whereas, reduction of hyperglycemia to control levels by insulin was only capable of reversing the sympathetic impairment (BRS slope of -0.28 ± 0.04). Our present results outline a framework for sequential involvement of different detrimental mechanisms in the course of metabolic disease leading to differential impact on cardiac autonomic control. Furthermore, our findings emphasize the value of early intervention with antidiabetic drugs with potential protective pleiotropic effects.

To identify the prevalence of work-related musculoskeletal disorders, levels of chronic occupational fatigue, and how they vary with individual and work organization factors.A multi-hospital cross-sectional survey.Nurses from 39 hospitals completed self-reported questionnaires from June to September 2015. Descriptive statistics were used to summarize hospitals and nurses' characteristics, fatigue levels and prevalence, and type of musculoskeletal disorders. Linear and logistic regression analyses were used to identify correlational factors.The results revealed that 71.3% of participants reported a work-related musculoskeletal disorder in the previous 12 months, mainly back pain. The reported musculoskeletal disorders were significantly correlated with years of experience, nurse to patient ratios, and chronic occupational fatigue. Higher chronic occupational fatigue levels were associated with education, age, years of experience, nurse to patient ratio, and model of care.Preventive work organization strategies are needed to ensure healthier occupational environment for nurses.目的: 确定与工作相关的肌肉骨骼疾患患病率、慢性职业疲劳水平,以及它们如何随个体因素和工作组织架构因素而变化。 设计: 一项多医院横断面调查法。 方法: 2015年6月至9月,39所医院的护士完成了自我报告式问卷。描述性统计用于总结医院和护士的特征、疲劳程度和患病率以及肌肉骨骼疾患的类型。采用了线性回归分析法和逻辑回归分析法来识别相关因素。 结果: 结果显示,71.3%的参与者报告,在过去的12个月中出现了与工作相关的肌肉骨骼疾患,主要是背部疼痛。报告的肌肉骨骼疾患与多年经验、护士与病人比例和慢性职业疲劳显著相关。较高的慢性职业疲劳水平与 教育状况、年龄、多年经验、护士与病人比例和护理模式有关。 结论: 预防性工作组织架构策略是保证更加健康型护士职业环境的必要手段。.

This study aimed to provide normative data for four trials of the Rey figure Test - a complex design used to assess visuoconstructional abilities, aspects of visual memory, and aspects of executive functioning. Despite its frequent clinical and research use in the Arab region, published studies regarding the measures' adaptation or normative data remain absent.We administered the Rey figure on a convenience sample of Lebanese (n = 254) aged 30 years to 99.We examined the impact of relevant demographics, and found that age, gender, and years of education impacted scores, and norms were derived based on these variables. Such normative data for the Rey figure enhance its practicality and psychometric adequacy for use in research and clinical settings in Lebanon.

Chronic liver disease is prevalent in obese patients presenting for bariatric surgery and is associated with increased postoperative morbidity and mortality (MM). There are no comparative studies on the safety of different types of bariatric operations in this subset of patients.The aim of this study is to compare the 30-day postoperative MM between laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-Y-gastric bypass (LRYGB) in the subset of patients with a model of end-stage liver disease (MELD) score ≥ 8.Data for LSG and LRYGB were extracted from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from years 2012 and 2013. MELD score was calculated using serum creatinine, bilirubin, INR, and sodium. Postoperative MM were assessed in patients with a score ≥ 8 and compared for the type of operation. This was followed by analysis for MELD subcategories. Multiple logistic regression was performed to adjust for confounders.Out of 34,169, 9.8% of cases had MELD ≥ 8 and were included. Primary endpoint, 30-day MM, was significantly lower post-LSG (9.5%) compared to LRYGB (14.7%); [AOR = 0.66(0.53, 0.83)]. Superficial wound infection, prolonged hospital stay, and unplanned readmission were more common in LRYGB. MM post-LRYGB (30.6%) was significantly higher than LSG (15.7%) among MELD15-19 subgroup analysis.LRYGB is associated with a higher postoperative risk than LSG in patients with MELD ≥ 8. The difference in postoperative complications between procedures was magnified with higher MELD. This suggests that LSG might be a safer option in morbidly obese patients with higher MELD scores, especially above 15.

The female-male ratio in the prevalence of post-traumatic stress disorder (PTSD) is approximately 2:1. Gender differences in experienced trauma types, PTSD symptom clusters, and PTSD risk factors are unclear. We aimed to address this gap using a cross-sectional design. A sample of 991 civilians (522 women, 469 men) from South Lebanon was randomly selected in 2007, after the 2006 war. Trauma types were grouped into disaster and accident, loss, chronic disease, non-malignant disease, and violence. PTSD symptom clusters involved re-experiencing, avoidance, negative cognitions and mood, and arousal. These were assessed using parts I and IV of the Arabic version of the Harvard Trauma Questionnaire (HTQ). Risk factors were assessed using data from a social support and life events questionnaire in multiple regression models. Females were twice as likely as males to score above PTSD threshold (24.3 vs. 10.4%, p ˂ 0.001). Total scores on all trauma types were similar across genders. Females scored higher on all symptom clusters (p0.001). Social support, social life events, witnessed traumas, and domestic violence significantly were associated with PTSD in both genders. Social support, social life events, witnessed traumas and domestic violence were significantly associated with PTSD in both genders. Conversely, gender difference in experienced traumas was not statistically significant. These findings accentuate the need to re-consider the role of gender in the assessment and treatment of PTSD.

Previous studies have shown that improving vitamin D status among the elderly may lead to an improvement in muscle mass and muscle strength. In our study, vitamin D supplementation showed significant improvements in vitamin D concentrations as well as appendicular muscle mass in pre-sarcopenic older Lebanese people. However, we found no significant effect on muscle strength. Improving vitamin D status might improve muscle function and muscle mass that lead to sarcopenia in older subjects. The aim of this randomized, controlled, double-blind study was to examine the effect of vitamin D supplementation on handgrip strength and appendicular skeletal muscle mass in pre-sarcopenic older Lebanese subjects. We also examined whether this effect differs in normal vs. obese subjects. Participants (n = 128; 62 men and 66 women) deficient in vitamin D (25(OH)D = 12.92 ± 4.3 ng/ml) were recruited from Saint Charles Hospital, Beirut, Lebanon. The participants were given a supplement of 10,000 IU of cholecalciferol (vitamin D group; n = 64) to be taken three times a week or a placebo tablet (placebo group; n = 64) for 6 months. One hundred fifteen subjects completed the study: 59 had normal weight, while 56 were obese. Strength and functional assessment and biochemical analysis were performed at the start and after 6 months. Compared to placebo, the vitamin D supplemented group showed significant improvements in appendicular skeletal muscle mass (ASMM) (P

Aim We examined the validity and reliability of nursing activity levels of complexity in the first Arabic version of the Actual Scope of Nursing Practice Questionnaire. Background Nurse executives need valid and reliable data on the scope and complexity of nursing practice to make decisions about cost-effective and safe deployment of the nursing workforce. We translated the English version of the Actual Scope of Nursing Practice Questionnaire into Arabic for use in Lebanon and the eastern Mediterranean region. Methods Data were collected from a national sample of bedside nurses in Lebanon in which 3,157 questionnaires were returned for analysis. We used multidimensional scaling, hierarchical cluster analysis, and confirmatory factor analysis to examine the Arabic Actual Scope of Nursing Practice Questionnaire levels of nursing complexity. Results Multidimensional scaling analysis and hierarchical cluster analysis confirmed the unidimensionality of the Arabic Actual Scope of Nursing Practice Questionnaire. Confirmatory factor analysis produced essentially the same fit statistics for the unidimensional model and three-dimensional models of item complexity. Conclusion The Arabic Actual Scope of Nursing Practice Questionnaire is a valid and reliable unidimensional measure of nursing complexity. Implication for nursing management Nurse executives and hospital managers in Lebanon and the eastern Mediterranean region can use total and mean Arabic Actual Scope of Nursing Practice Questionnaire scores as aids when making decisions about nursing workforce deployment.

We prove a Black–Scholes type formula when the geometric Brownian motion originates from approximations by multinomial distributions. It is shown that the variance appearing in the Black–Scholes formula for option pricing can be structured according to occurrences of different types of events at each time instance using a local limit theorem for multinomial distributions in Richter (1956). The general approach has first been developed in Kan (2005).

The use of bisphenol A (BPA) in packaging has grown over the past 50 years despite concerns of its migration into packaged food and beverages, resulting in human exposure. Many studies have reported tumorigenic effects and endocrine alterations associated with BPA in animal models. This study aims at assessing human exposure to BPA from olive oil. A total of 27 olive oil samples were collected from mills and local villagers in the Hasbaya District, a major olive oil harvesting region in Lebanon. Information on storage conditions was also collected. BPA was extracted and quantified by HPLC. Results showed significantly higher BPA levels in olive oil samples stored in plastic vs. non-plastic packaging (mean = 333 vs. 150 μg/kg, p value = 0.006), samples with a plastic storage duration of >1 year compared to those with a storage duration of

Mercury (Hg) exposure represents a significant public health concern at a global level. This study aims at assessing Hg exposure and risk among Lebanese young adults based on Hg biomonitoring and seafood intake. A group of 166 young adults were administered a questionnaire to assess Hg exposure and were asked to provide a hair sample. Risk assessment was performed: (1) using the US Environmental Protection Agency Hazard Quotient (HQ) model based on fish intake and previously studied local fish Hg concentrations, and (2) by determining the total hair Hg concentration (THHg) using continuous flow-chemical vapor generation atomic absorption spectrometry. Differences in THHg across demographic and exposure subgroups were tested using t test or ANOVA. Correlations between THHg concentrations, fish consumption, and HQ were determined by computing Pearson’s r. Higher THHg correlated with higher consumption of Mediterranean rabbitfish/spinefoots (r = 0.27; p = 0.001) and geographical location (p

Blood pressure exhibits substantial short‐ and long‐term variability (BPV). We assessed the hypothesis that the complexity of beat‐to‐beat BPV will be differentially altered in salt‐sensitive hypertensive Dahl rats (SS) versus rats protected from salt‐induced hypertension (SSBN13) maintained on high‐salt versus low‐salt diet. Beat‐to‐beat systolic and diastolic BP series from nine SS and six SSBN13 rats (http://www.physionet.org) were analyzed following 9 weeks on low salt and repeated after 2 weeks on high salt. BP complexity was quantified by detrended fluctuation analysis (DFA), short‐ and long‐range scaling exponents (α S and α L), sample entropy (SampEn), and traditional standard deviation (SD) and coefficient of variation (CV(%)). Mean systolic and diastolic BP increased on high‐salt diet (P

Objectives To compare hearing outcomes in patients with far advanced otosclerosis (FAO) undergoing cochlear implantation to an age-matched group of controls, to describe the effects of cochlear ossification on hearing, and to review the adverse effects of implantation in patients with FAO. Hypothesis Hearing performance in patients with FAO after cochlear implantation is comparable to similarly treated postlingually deafened adults without FAO. Ossification or retrofenestral otosclerosis does not predict poor hearing outcomes. Modiolar-hugging technology reduces postoperative facial nerve stimulation. Study design Retrospective chart review. Setting Academic neurotologic tertiary referral center. Patients Thirty patients with FAO, who metaudiological criteria for cochlear implantation, were compared to 30 age-matched controls, postlingually deafened by non-otosclerotic causes. Main outcome measures Audiometric pre- and postoperative speech reception threshold, word, and sentence scores were analyzed. The presence of retrofenestral findings on computed tomography or intraoperative cochlear ossification were noted. Results In the FAO group, radiographic abnormalities were noted in 26.4% of patients. Intraoperative ossification requiring drillout was seen in 29.4% of patients. None developed postoperative facial nerve stimulation. There was no difference between the FAO and control groups in the mean short-term and long-term postoperative speech reception threshold, word, and sentence scores (P = .77). The presence of radiographic abnormalities did not predict hearing outcome. Intraoperative cochlear ossification was not associated with worse short-term word and sentence scores (P = .58 and 0.79, respectively), and for the long-term hearing outcome (P = .24). Conclusions In patients with FAO, effective and safe hearing rehabilitation can be accomplished with cochlear implantation.

Background While population aging challenges Arab governments to ensure well-being in old age, knowledge translation is gaining support worldwide in evidence-based policymaking and service provision. This study examines the status of existing knowledge translation efforts of aging-related research in Arab countries and evaluates the additional role that institutional arrangements (such as ministry departments, national committees, etc.) play in the relationship between knowledge creation and social and health policies and programs. Methods Data were triangulated from two regional surveys and a supplementary desk review of academic, civil society, ministry, and UN documents. Using a set of indicators, standardized summative indices (out of 100) were generated for five constructs, namely knowledge creation, institutional arrangements, knowledge translation, and health and social policies and programs. Correlations were assessed using Spearman’s rank correlation (rs), and bootstrap multiple linear regression models were used. Results Arab countries scored highest on the institutional arrangements index (median = 69.5), followed by the knowledge creation index (median = 45.9), and lowest on the knowledge translation index (median = 30.2). Both institutional arrangements and knowledge creation significantly correlated with social and health policies and programs. However, when adjusted for knowledge translation, only institutional arrangements retained a significant association with both outcomes (rs = 0.63, p value =0.009 and rs = 0.69, p value =0.01, respectively). Adjusting for institutional arrangements and knowledge creation, the association of knowledge translation with social and health policies and programs was attenuated and non-significant (rs = 0.08, p value =0.671 and rs = 0.12, p value =0.634, respectively). Conclusions There are two key messages from this study. Firstly, institutional arrangements play a central role in aging social and health policy and program development in the Arab region. Secondly, knowledge translation paradigms in Arab countries may be deficient in factors pertinent for promoting evidence-based decision-making and policy-relevant research. These findings call for the need of strengthening institutional arrangements on aging and for promoting knowledge production that meets policy-relevant priorities. Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0360-8) contains supplementary material, which is available to authorized users.

Objective Establish the time to safely and efficiently perform cochlear implantation (CI) in a university-based academic center. Study Design Case series with chart review. Setting Academic neurotologic referral center. Patients 424 patients who underwent CI surgery between 2002 and 2010. Intervention Unilateral, bilateral or revision CI using commercially available devices approved for use in the United States. Main outcome measures: mean surgical duration (SD) and mean total operative room time (TORT). Results Overall mean SD for all 424 patients was 83 ± 30 min (min) whereas the mean TORT was 135 ± 56 min. The mean SD for unilateral CI was 84 ± 18 min for the first implant and 82 ± 22 min for the second implant (p = 0.55). The SD for primary and revision CI was 83 ± 18 min and 85 ± 36 min, respectively (p = 0.51). The mean SD for pediatric and adult CI was 83 ± 21 min and 83 ± 18 min, respectively (p = 0.92). The mean SD without resident assistance was 74 ± 14 min whereas with the assistance of a resident the mean SD was 84 ± 20 min (p = 0.02). When ossification was encountered the mean SD was 90 ± 32 min compared to 82 ± 19 min when absent (p Conclusion In a university-based academic center, CI surgery can be safely and efficiently performed, supporting future cost-effectiveness analysis of its current practice.

mm Hg (SD: 12). Upon repeat BP measurement, the systolic BP decreased by a mean of 11 mm Hg (95% CI: 8.3 13.7, p