The long necks of sauropods have been subject to many studies regarding their posture and flexibility. Length of the neck varies among groups. Here, we investigate neck posture and morphology in several clades from a mechanical viewpoint. Emphasis is put on comparing sauropod necks and tails with structures in living archosaurs and mammals. Differences in the use made of necks and tails lead to clear-cut differences in the mechanical loads occurring in the same models. Ways of sustaining loads are identified by theoretical considerations. If the observed skeletal structures are suited to resist the estimated loading in a particular posture, this concordance is taken as an argument that this posture or movement was of importance during the life of the individual. Apart from the often-discussed bending in side view, we analyze the often overlooked torsion. Because torsional stresses in a homogenous element concentrate near the periphery, a cylindrical cross section gives greatest strength, and the direction of forces is oblique. In a vertebrate neck, during e.g. shaking the head and twisting the neck, oblique muscles, like the mm. scaleni, if activated unilaterally initiate movement, counterbalance the torsional moments and keep the joints between neck vertebrae in equilibrium. If activated bilaterally, these muscles keep the neck balanced in an energy-saving upright posture. The tendons of the mm. scaleni may have ossified as cervical ribs The long cervical ribs in brachiosaurids and mamenchisaurids seem to have limited flexibility, whereas the shorter cervical ribs in Diplodocidae allowed free movement. The tails of sauropods do not show pronounced adaptation to torsion, and seem to have been carried more or less in a horizontal, extended posture. In this respect, sauropod tails resemble the necks of herbivorous cursorial mammals. These analyses provide an improved understanding of neck use that will be extended to other sauropods in subsequent studies. Mamenchisaurus, Omeiosaurus) the neck was extremely long, making up approximately half of the entire body length of the animal. This was the result of an increase in the number of cervical vertebrae (up to 19) and partially also of the elongation of the single elements Dicraeosaurus and Brachytrachelopan are the exceptions among Sauropoda because they had rather short dimensioned necks , which possess unusually long and split neural processes. These forms are not considered here but will be the focus of a future study.Sauropoda are a major clade of the Dinosauria (Saurischia) and the largest animals that ever lived on land, reaching body masses up to 70 tons or even more , at least in taxa such as e.g., A weak point of previous approaches to neck mechanics is their bias towards bending of the neck under the influence of weight and balancing of the head and neck weight in lateral view. Several basic biomechanical facts were not given adequate attention in this context. This is particularly the occurrence of torsional loads in flexed necks that had been recognized already by Dzemski and Christian Giraffatitan brancai and mamenchisaurids. In Shunosaurus and Diplodocoidea, the posterior processes of the cervical ribs are commonly shorter.Little attention has so far been paid to the meaning of the cervical ribs, which occur in all amniotes but are often reduced; e.g., in mammals. A typical cervical rib runs nearly parallel to the neck axis and carries an anterior and a posterior process Frey and Martin Alligator missisipiensis), of the ostrich (Struthio camelus), and of the sauropodomporh Plateosaurus engelhardi, also show longitudinal fibers instead of periosteal bone, indicating their origin as ossified tendons  implies for neck posture and neck mobility in sauropod dinosaurs and how their cervical ribs can show such a marked tendency for elongation and ossification. We intend to develop a complete explanation for at least one among the varying shapes of necks in sauropods.Our basic hypothesis is that all parts of the locomotor apparatus, including the neck, are optimized for fulfilling their functions that are “adapted” to sustain the loads applied during every-day life, while being as lightly built as possible with the available materials. This is in accordance with evolutionary theory and with Wolff´s law The most promising way to obtain better understanding of morphology is the investigation of extant vertebrates. The moments and internal forces evoked in static and kinetic conditions, as well as the skeletal and muscular structures, which resist these internal forces, can be studied directly in living forms. Because sauropods are extinct and have no living counterpart, this aim can best be approached by investigating their closest living relatives, crocodiles and birds, and functionally similar conditions in large cursorial mammals.Crocodiles, however, do not have a very long neck, which characterizes sauropods. In addition, crocodilian tails fulfill a very special biological role, namely propelling the animal in water. Therefore, they are not fully convincing models, especially for studying the bending stresses in a long neck. The conditions of balancing the head in common terrestrial postures must be fulfilled by their morphological structures  as well. Crocodiles do, however, show a behavior by which the neck is exposed to pure torsion: the often so-called “death roll” they use for hunting and feeding. As long as the animals are supported by water, no strong bending moments due to gravity obscure the torsional stressing of the neck. Special morphological traits of the crocodilés neck therefore seem to depend largely upon torsion and can be considered as “adaptations” to torsional loads. Therefore, it is reasonable to search for convergences of neck morphology between crocodiles and sauropods in spite of their obvious morphological and behavioral differences. Likewise, the tails of sauropods can be compared with those of crocodiles, although the use in each animal is different.Obtaining data on internal forces is technically very difficult, and inflicting damage to the experimental animal is nearly inevitable. External forces can be measured with the aid of extremely expensive machinery. Muscle activities are relatively easy to monitor by using the EMG technique, but the data obtained do not tell the whole story. The most relevant shortcoming is that EMG does not yield reliable data on the forces exerted by muscles. Therefore, the simplest way to develop a reliable idea about the biomechanical conditions is a theoretical approach, which is based on standard mechanical laws.The theoretical approach begins with precisely defined and plausible data and calculation of internal forces and stresses that show which structures are required and which shapes fit best. In fossils, the argument must be inverted: Only the skeletal structures are known, and we try to derive from them – under the premise of the basic working hypothesis of perfect “adaptation” of structures to function – the internal forces, the external loads, and finally body posture and the mode of locomotion. While the first step is quite reliable, the third and fourth steps are increasingly hypothetical – although still based on the laws of physics. Since these laws are generally valid, any agreement of traits in a living animal with identified mechanical rules confirms the correctness of the basic working hypothesis. The opposite, of course, is also true: If no agreement can be found, something must be wrong – in most cases, the error lies in the assumptions about stresses, which occur in particular movements.m for mass, F for force, r or l for length of the lever arm, or other distances. The product of the latter, the “moment” is named M. Weight is the product of mass (m) times Earth' acceleration (g).The technical models were transformed to fit the shapes of animals. Extant animals that can be observed are the most informative, with emphasis on their neck posture and mobility as well as on their locomotive behavior. During locomotion the highest forces occur and must be sustained by the animal. If this condition is not met, the resulting failure is fatal for the animal. Lower forces, which occur in social or comfort behavior, of course can be sustained by stronger structures. Extant animals also can be dissected to identify the soft-part structures like ligaments and muscles, including their insertions at the skeleton. Information about the skeleton can be derived from both extant as well as extinct forms. Fossils only reveal information about their skeletons (bones) – the aim of our work is to obtain the missing information about their “mechanical function” in the sense of Bock and v. Wahlert The methods of theoretical mechanics are described in detail in several textbooks. Our preferred references are Lehmann Brachiosaurus  and Diplodocus  were studied first hand. In addition, published illustrations of a number of other Sauropoda were considered. Our study is also based on first-hand observations and measurements of skeletons of several recent cursorial mammals in the collections of Institut d´Anatomie of the Université Louis Pasteur in Strasbourg, France, and the Naturmuseum Senckenberg, in combination with repeated observations of locomotor behavior of extant mammals. Names of the muscles follow the terminology of Fürbringer Most specimens considered in the current study are on display in public museums. All mentioned museums gave permission to study the specimens in their exhibition and/or collection.The sauropods bending, evoked by the masses of the segments of the beam, or body stem, multiplied with gravity ( =  weight forces) and lever arms ( =  bending moments). The weight forces act in a vertical direction and their lever arms are greatest if the neck is kept horizontal. This leads to very high bending moments, which must be counteracted by tension-resistant structures  on the dorsal side of the neck. The morphological “adaptations” of the sauropod neck to bending under the influence of body weight have received much attention in the literature Seen from the side, the body of a quadrupedal animal can be compared roughly to a beam, or girder, with two cantilevers on either side, jutting out forward (head and neck) as well as rearward (tail) . This comn * ln < Fmt * lt) nor its mass moments of inertia (Fmn * ln2 < Fmt * lt2) can become greater than that of trunk plus tail plus extremities. The same fact was noted by Taylor and Wedel Two sometimes neglected, though very simple, conditions become clearly visible in side view: first, alone muscles can keep a neck at variable heights, while the given lengths of ligaments place it in one, invariable position. Second, the absolute maximum for all moments evoked by the neck is set by the trunk mass: Neither the static moments of the neck (Fmi). These forces are multiplied with their distances from the pivot to yield ventrally directed bending moments (Fi * lim). The bending moments add up to a maximal value at the pivot that is the joint between the most proximal neck vertebra and the most cranial thoracic vertebra , following the formula: 1  =  L * cosine α, where L is neck length and α the angle against the horizontal , the whole space between the vertebrae and the contour being filled with tension-resistant soft tissues. The lever arms are long because the nuchal ligaments and the muscles have their origins at the spinal processes of the anterior dorsal vertebrae, between the transverse processes (and ribs) and their tips. The reverse is true in the tails. The spinal processes are elongated in the anterior thoracal segments, forming something like a “withers” . AlthougtM) are defined by t  =  F * rM, where F is the weight of the segments distal to the bend, and r the distance from the longitudinal axis of the proximal neck to the center of mass (CoM) of the laterally flexed segments. Additional information can be supplemented by looking at the neck in anterior or dorsal views. m1, Fm2, and Fm3 , m. rhomboideus , and at the neck segments two to four, deep layers of the m. cervicis . Group Fm2 includes the m. levator scapulae or m. serratus profundus  and, at the posterior neck segments, the m. multifidus. Component Fm1 is provided by the m. scalenus . The m. sternomastoideus has the same function but crosses the whole distance from sternum to head without contact to the neck vertebrae.The parapophysis of the vertebra connect the capitulum of the cervical ribs to the axial skeleton, and the diapophysis of the vertebra connects the tuberculum of the cervical ribs to the axial skeleton, and thus both keep the twisting forces far away from the neck´s longitudinal axis. Their long lever arms , 9 allowThe long posterior processes of the cervical ribs of sauropods contain mostly longitudinal fibers Not so easy to answer is the question why muscles are recruited for ventral flexion in a forwardly inclined neck of a sauropod, because the weight of neck segments and the enormous distances from the segments to the base of the neck yield ventrally bending moments without any expenditure of energy – as was discussed often in the literature e.g.  and is iThe second question raised above, to which muscle the ossified tendons belonged, is difficult to answer because soft part anatomy is not preserved and the functional analogs are contradictory: In crocodiles as well as in sauropods, the posterior processes deviate from the vertebrae caudally, which is visible in dorsal and in lateral view. They point towards the direction of a rather lateral origin, perhaps on the anterior ribs like the m. scalenus Fm3 in . From a Diplodocus, Apatosaurus, and Alligator), these rigid elements do not at all influence flexibility of the neck. At the level of the intervertebral junctions, the tendons consist of collagenous fibers, which can easily be deflected. If the posterior processes of the cervical ribs are longer than one segment (such as in Giraffatitan and mamenchisaurids), they approach the neck vertebral column on the concave side, while being removed from the vertebrae on the convex side of the flexion. If the posterior processes are ossified tendons, the lever arms of these tendons at the concave side of neck flexion  are long at the nearest intervertebral joint, but decrease posteriorly until they make contact with the vertebral column. At the convex side of the curvature, the lever arms of the pulling forces increase continuously in the posterior direction, making the effect of a contraction stronger and stronger. At the posterior tip of the cervical rib, the tendon must be tied to the vertebra, either by muscular fibers attached to the bony element or by tough connective tissue, which redirects the direction of pulling force. No histological evidence exists for such a tying, however Sauropod necks are divided into 14 to 19 neck segments, which can be moved against each other. This is similar to the situation in birds, which has been investigated systematically by Dzemski . The excIn the case of sauropods, no realistic idea seems to exist as to what the animals did with their tails – except keeping them horizontally and serving as the posterior insertion of the caudofemoralis muscle Like the necks, the long tails of reptiles are exposed to bending moments because of their weight, especially if carried without ground contact more or less horizontally.In the case of most dinosaurs no traces of drag marks of the tail have ever been found, so we may assume that this appendage was kept in a rather invariable position at the level of the pelvis, well above the ground. In view of their limited mobility, a “specialized” profile, as is characteristic for the necks of mammals see also  can be eDiplodocus, for example, the caudal vertebrae posterior to the second caudal show hemapophyses. In all cases, the “strong”, that is broad and rearward inclined, dorsal processes are rigidly fused to the neural arches, whereas the more slender ventral processes are weaker and not rigidly fused to the centra, but attached to them in a sort of joint. Although only a part of the muscle fibers is attached to the spinal processes, the major part of the supraspinal ligament is fixed to the tips of the long spinal processes. The exact direction of the resultant of all tensile forces acting on the spinal processes is not predictable. Therefore, height resistance of the rigid dorsal processes makes sense. Their inclination keeps bending moments within the neural processes and at their bases  of variable length in addition to the long dorsal neural spines. In ir bases  at a low2) without expenditure of energy and their lower weight. Muscles, by contrast, are weaker , much heavier and require much energy if actively contracted. The musculature of sauropod tails commonly is reconstructed on the basis of homology, or as in this study, of  biomechanical needs. Homology can be based on the muscles of crocodiles. Unfortunately, the information in the literature is not precise, but confined to generalized statements about the stem musculature. Often authors classify muscles just as “primitive”, meaning that muscles are segmented and arranged similar to fish tails.If indeed the position of the tail was invariable, the tensile structures to support the tail may possess a definite length, like ligaments, rather than being able to adapt their lengths, like muscles. In fact, some dinosaurs, such as hadrosaurs, show ossified structures in their skeleton comparable to the muscle insertions in As noted above, the hemapophyses of the tail vertebrae are attached to the centra by joints, which provide long lever arms for the hypaxial muscles while permitting longitudinal flexion of the skeletal elements against the body axis instead of sustaining torque. In the transverse direction, the two branches forming the hemal arch provide remarkable strength against being bent in the transverse direction. The increase of strength follows a parabolic function, corresponding to loads distributed over the whole length of the hemapophyses In the absence of direct evidence for tail use and tail function in sauropods, it seems worthwhile to go into details of tail anatomy and function in their closest extant relatives. Crocodiles and also lizards usually tow their tails behind when walking on the ground, and lift it only in rare cases and for a short time off the ground. Bending and torsional moments are reduced by this behavior. In crocodiles that walk rapidly  or run on firm ground, the tail is partly balanced by the dorsal muscles, while during the “low walk” or slithering, the tail is propped against the ground or resting on it and gives the caudofemoralis muscle a solid, immobile caudal insertion for retroverting the hind limbs According to Gatesy external equilibrium of the whole animal. The external equilibrium requires that Because of its length, neck posture exerts a strong influence on the if the neck is kept horizontally, or, if the neck is elevated, .F) equals the sum of reaction forces , than a vertically erected neck (Fv2). In other words, the center of total body mass is shifted forward by stretching the neck horizontally, and shifted rearward by assuming a more upright position. If a mass distribution similar to Henderson From the condition of equilibrium of forces  follows that the sum of all segment weights  of the skeleton, but what is missing is the functional meaning of these characters. Nevertheless, it is quite usual to talk about “adaptations”, without considering that the use of this word implies a functional hypothesis. These hypotheses are often not justified. Only if the functional value of a character can be defined clearly (perhaps quantitatively!), we may conclude that the characters are “adapted”. According to Wolff Regardless of their preferred inclination, sauropod necks are exposed to bending. The lengths of the lever arms may vary, following the cosine of the inclination angles. Sauropod necks are also exposed to considerable torsional moments. In spite of light-weight-constructions Meleagris and Grus  can be explained.In mammals, necks are not really long in comparison to sauropods The necks of cursorial herbivorous mammals can be classified as morphologically specialized for sustaining high bending moments in lateral view. In so far, mammalian necks and the tails of sauropods are similar. The farther removed the tension-resistant fibrous  or muscles from the neck vertebrae, the longer are the force arms and the greater their torques. The lever arms are long because the nuchal ligaments and the muscles have their proximal insertions at the anterior thoracal vertebrae, (between the transverse processes and the ribs) and at the tips of the spinal processes. Especially the latter are elongated in the anterior thoracal segments, forming the “withers” of cursorial mammals . The lacThe neck construction of mammals also provides oblique muscles to sustain torsion, but these muscles usually bridge a large part or even the whole distance between thorax and the heavy head that, because of its mass, causes particularly high torsional moments . It should be noted that the necks of, e.g., carnivores do not have the high and narrow neck profile so typical of the large herbivores. The more circular cross sections of carnivores give their necks higher resistance against torsion. Because the necks of the hooved mammals are specialized for sustaining high bending moments, their neck construction permits the use of horns, antlers, or simply the frontal bone in intraspecific or interspecific fights . In terms of mechanics, these external forces are concentrated on the head and therefore have the longest possible lever arms along the neck, which is strongly bent when transmitting the external forces to the trunk. The fighting animals take care to keep these forces more or less in the sagittal plane and thus keep torsion within narrow limits. The energetically cheapest means to control bending of the neck under the influence of ventrally flexing moments, while keeping it in various positions, are long lever arms of muscles. The latter are obviously powerful, especially in males.The mobility of necks in the large cursorial mammals is limited; they can usually reach their hindquarters by the teeth, but often not their backs. Extreme mobility of the neck can be observed among carnivorous mammals, especially in seals and elephant seals. These necks are characterized by strong vertebrae without long bony processes, and the very strong musculature is arranged in accordance to the muscles in other mammals. It should be noted, that necks of seals are – on land, under the influence of earth gravity – rarely kept in horizontal postures without bracing their heads on the ground. By contrast, seals show a clear tendency to place their necks into a vertical position for resting, basking, or display behaviors. If submerged in water, the necks lose their weight (but not their mass!) and therefore can be kept parallel to the body axis.The tails of most mammals are unimportant for the general equilibrium and do not play a large role, because they neither contain much mass, nor are they kept in a more or less horizontal position in which they exert influence on the system. Some exceptions from this rule can be found among marsupials.Long-necked birds  can be seen as functional analogues of sauropods see also . During The usefulness of this analog, however, is doubtful, simply because the equipment with muscles theoretically can be, and in fact seems to be, quite different in both groups, in spite of the otherwise far-reaching homology of the musculature. In birds, the most obvious flexor of the neck is the m. longus colli ventralis However, the subdivisions of the avian m. longus colli ventralis can hardly be considered as homologous to sauropod cervical ribs, because their common origin is along the ventral midline of the neck, instead of deviating from the midline, and because the tendons do not insert into the long and slender “processus costales” of the bird vertebrae. Instead, these structures are the insertions of the segmental m. longus colli lateralis All we know about animal behavior indicates that every possible attempt is made to reduce the expenditure of muscle force; that is,horizontal neck posture is not probable as a frequently assumed or “resting” posture. The influence of gravity on neck posture can easily be observed in many birds . If a loSuperficially, snakes seem to move their most cranial parts in a way similar to that postulated here for sauropods. These anterior parts of snake bodies, however are not necks, but anterior parts of the trunk, with its common equipment: Ribs and intercostal musculature. These anatomical elements have been identified by Preuschoft et al. Aside from the often-discussed bending in side view, necks of sauropods are exposed to torsion. This requires particular adaptations, especially because of the concentration of internal forces derived from torsion near the periphery of the twisted element. Very similar adaptations to torsional strength can be seen in crocodiles, which expose their admittedly short necks to huge torsional moments in the death roll. By contrast, the tails of sauropods do not show pronounced adaptation to torsion, and seem to have been carried more or less in a horizontal posture. In this respect, sauropod tails resemble the necks of large cursorial, herbivorous mammals. The high number of short neck segments is an indicator of neck flexibility, while long segments limit flexion, as do long dorsal and ventral apophyses.The cervical ribs of some sauropods resemble functionally the tendons of a muscle group named in birds the m. longus colli ventralis, which gives raise to long tendons, inserting into each neck vertebra. The muscle bellies, however, are located more medially on the centra of the posterior vertebrae and do not insert into the processus costalis of the avian neck vertebrae. The direction of the cervical ribs in sauropods indicates a more lateral insertion, like that of the m. scalenus in crocodiles, which is contrary to Taylor and Wedel If acting on both sides, these muscles flex the neck ventrally – a movement that seems completely unnecessary in the heavy necks of sauropods if carried forwardly inclined. The existence of a strong ventral muscle is reasonable only if the neck is kept upright – a posture that saves energy. According to Christian [this collection], the m. longus colli ventralis may have an important function to counteract passive movements of the long sauropod neck in locomotion. No doubt, the muscle of which the ossified tendons seem to be the cervical ribs is perfectly suited to keep the neck in balance against torsional moments by unilateral activity. The forces produced by these muscles are further transmitted from the transverse processes to the spinal processes by the deep fibers of the m. longissimus system (multifidus cervicis) and m. splenius capitis.In conclusion, the necks of diplodocids seem to have been very flexible, permitting smooth adaptation to a variety of postures, while those of brachiosaurids were more restricted and still more so the necks of mamenchisaurids. Unilateral activation of the m. longus colli ventralis or the mm. scaleni contributes in sauropods to shaking the head and twisting the neck, as well as to resisting torsional stresses in crocodiles.


Clostridium difficile colitis.The human microbiome, meaning the total group of microbes that constantly populates a human being, has been intensively studied in the lasts years. The gut microbiota seems to be the most important part of it, not just regarding the number of cells and diversity, but for the almost unbelievable role in maintaining health, acting on the immunity-disease axis. The gut can be interpreted as a “microbial organ” and one obvious aspect of its deterioration, mainly as result of antibiotics misuse, is Clostridium difficile infection. Fecal bacteriotherapy consists in transplantation of a small quantity of feces from a healthy donor to another person with abnormal intestinal flora.In order to reverse the altered gut flora, a team consisting of clinicians and microbiologists developed a protocol, in accordance with internationals protocols, with specific procedures, for performing fecal bacteriotherapy in patients with recurrences of Clostridium difficile recurrence (ATLAS score <5); one case received the fecal transplant by enema and one by nasogastric route. The procedure was well tolerated. The evolution was favorable with rapid remission of diarrhea in the next 48 hours and with no relapses in the 30 days of follow-up.Two female patients aged 80 respectively 83 years old received fecal bacteriotherapy in our Institute, for the second, respectively for the third Clostridium difficile infections failure to standard treatment.It is necessary to extend the experience with this treatment, the fecal bacteriotherapy being a viable alternative for


Thombs and colleagues have shown that screening consecutive attendees in primary care settings in high income countries for depression is not worthwhile. However, it is dangerous to generalize from high income countries such as the USA to the rest of the world. The positive predictive value of any screening test for depression is affected by the prevalence of the disorder in the population being considered. Populations with an increased prevalence of depression, such as those with chronic physical disorders, or with a history of depression or other mental health problems may benefit from screening, even in high income countries. Populations in low and middle income countries (LMIC) may also benefit from screening if they are experiencing severe social adversity, including poverty. Two examples are given, in which screening with a brief screening questionnaire was followed by collaborative stepped care, to the considerable benefit of the patients in LMIC.http://www.biomedcentral.com/1741-7015/12/13.Please see related article:  Diagnostic and Statistical Manual (DSM) system of the American Psychiatric Association [Thombs and colleagues  have broociation .The original National Institute for Health and Clinical Excellence (NICE) guideline for depression  concludeet al. [Thus, at 10% prevalence, a test with a sensitivity of 90% and a specificity of 85% would have a PPV of only 40%, so a clinician could be forgiven for not wishing to be influenced by a test with such a low chance of being correct. However, the same test at a prevalence of 45% would have a PPV of 83.5%. The negative predictive value is affected to a much smaller degree, being 98.7% at 10% prevalence, but is a still acceptable 91.2% at a prevalence of 45%. It can be seen that in high prevalence populations, the same screening test works very much better than it does in predominantly healthy populations. For example, Whooley et al.  argue thMany populations of people seeking care in low and middle income countries (LMIC) have a high prevalence of psychological disorders: for example, in the World Health Organization study  of MentaOf course, these high prevalences do not apply to all settings in LMIC, but they are common wherever social adversity and poverty are marked, so that use of screening tests is widespread in these countries. In recent years, some of the older tests such as the 12-item General Health Questionnaire (GHQ-12) -15, the However, two further things are also necessary, other than a high prevalence of depression in the population to be screened, and these involve both healthcare provider and patient The doctor must have the ability to both diagnose and assess the severity of the depression, and must be able to provide effective treatment. It is also helpful if the doctor is perceived by the patient as someone with whom it is easy to communicate. The patient must be prepared to admit that they have a need for an intervention, be allowed to choose what treatment they receive, and to invest both time and cooperation in such treatment.et al., the CSC condition meant that all patients with high scores on a screening questionnaire were given psycho-education by the lay counsellors, but in patients with higher scores this was supplemented by an antidepressant by the primary care physician. Psycho-education taught patients strategies to alleviate their symptoms, using techniques such as breathing exercises for anxiety symptoms and scheduling activities for symptoms of depression. Moderately or severely ill patients who were offered drug treatment could also have group interpersonal psychotherapy from the lay health worker. A later paper [Both of these examples ,15 used er paper  followedet al. [In the study by Araya et al. , low-incet al.  considerIt is to be hoped that future studies in all populations in which an increased prevalence of depression may be expected will continue to use brief screening procedures to detect depression. In LMIC, CSC offered by a trained non-medical health worker has been shown to produce excellent results.The author is responsible for the General Health Questionnaire, and shares the Copyright with the Institute of Psychiatry, King’s College, London, UK.The author is Chairman of the Primary Care Consultation Group for ICD-11 of the World Health Organization.


Hepatitis C virus has been considered to be one of the most important devastating causes of chronic hepatitis, cirrhosis, and hepatic cellular carcinoma. The prevalence of such virus varies greatly over the world. Arab world has a unique geography and consists over nineteen countries who share the same heritage and customs and do speak the same language. In this area, the epidemiology of hepatitis C is not well understandable. Hepatitis C virus was found to be endemic in Arabia. The serostatus of such virus was found to be variable among these countries with uniform patterns of genotypes. Such prevalence varies tremendously according to the risk factors involved. Blood and blood products, haemodialysis, intravenous, and percutaneous drug users, and occupational, habitual, and social behavior were found to be the important factors involved. Hepatitis C will have major social, economic, and even political burdens on such young and dynamic societies. Thus, strategies and clear policy of intervention are urgently needed to combat the consequences of HCV both regionally and at state level of each country. Hepatitis C virus has been considered to be one of the most potential pathogens that have hindered the medical community all over the world. Indeed, since its discovery in 1989, hepatitis C virus (HCV) has been recognized as a major cause of chronic liver disease worldwide and due to the surpassing hepatitis B virus . Such in Arabian compound states are composed of unique geography being the central and transcross of the world. It is composed of more than nineteen countries with more than 350 million; they all speak the same language and mostly they have the same heritage and customs. Indeed it is the whole site of east and south of the Mediterranean basin up to the Atlantic cost in the west and Persian gulf and Indian Ocean south east. The African region is composed of the whole north African countries which are composed of approximately 23% of Africa, though the Asian region composed most of the north west of Asia and composed around 10% of Asia. Such area has over 30% of the world oil revenue, and most of them enjoy great wealth and prosperous capital.The global epidemiology of HCV varies greatly allover the world, and different studies have shown such variations. Hepatitis C virus was found to be endemic in certain countries, and different studies have confirmed such endemicity . It is iNowadays, HCV is responsible for infecting over 20 million in Arab countries, and without immediate and effective intervention, that number is predicted to increase tremendously in the next two decades. The objectives of this paper were to analyze the status of HCV epidemiology among the Arab countries and its variation accordingly and to highlight the future consequences and how to overcome the implications of such infection.The Arab world consists of heterogeneous countries with various levels of developments and different approaches of concepts and priorities. Infrastructure of health services is variable among these countries; some of them succeeded in adapting the modern routes of infection prevention; others fail and rarely adapt such recommendations . However Arabian peninsula is unique geographical area a composed 35% of Arab world that it is composed of Saudi Arabia, Yemen, Oman, Qatar, Bahrain, UAE, and Kuwait. Saudi Arabia is the largest country not only in the Arabian peninsula but in the Arab world, and considered to be the richest. Hepatitis C virus is well studied in Saudi Arabia, and its serostatus is known among the different population . The uni This region is composed of Syria, Iraq, Lebanon, Jordan, and the existing Gaza Strip . Different studies were carried out in Syria on the prevalence of HCV among different categories . The pre In Iraq, the prevalence of HCV ranged from 3.21 to 7.1% among the pregnant women and general population of four HCV genotypes, 1a, 1b, and 3a , 27. A s HCV is less frequent among Lebanese; it ranged from 0.16 to 1.22% among healthy volunteers, blood donors, and health care workers, though it was 27% among haemodialysis patients . Genotyp The collected data form Jordanian studies was found to be variable and even contradicting. The overall prevalence of HCV among Jordanian people varied from 0.65 to 6.25% depending on the population studied . It was  Hence then, over two million with 0.7–6% of prevalence were infected in Sham region; the lowest prevalence was reported in Lebanon followed by Syria, Gaza strip, and then Jordan and Iraq, though the HCV genotype 4 was the commonest among all the regions a part from Jordan which do need further elucidation. Sudan and Egypt are the main countries to be considered in this region as they were resting on the Nile River which originated from the Ethiopian mountains to cross Sudan and pass via Egypt to the Mediterranean basin and indeed its one of the oldest ancient civilizations in the world. Hepatitis C virus has been intensively studied in Egypt, and great efforts have been shown in this important area . The preThe status of HCV among Sudanese is also obvious as it is reported to be (2.2–3%) among the general population , 45. HigHence then, the Nile River region was considered to be the highest endemic area in prevalence of HCV with 15 million infected persons particularly genotype 4 as shown in  The Arabian North African countries include Libya,Tunis, Algeria, Morocco, and Mauritania, (Mauretania). The prevalence of HCV and its genotypes among different populations at Maghreb countries is variable. In Libya, HCV has been intensively studied by Daw and his collaborators over the last ten years; the prevalence of HCV among Libyans was 1.2% though among hemodialysis was 20.2% . RecentlDifferent studies were also carried out in Tunis , 51; theIn Morocco, the prevalence of HCV was reported to be high. It varies greatly from one study to another. It was found to be 1.93% in a study carried out by Beghdadli et al. , while iDespite the clear picture of HCV epidemiology in Libya, Tunis, and to a certain instant in Algeria and Morocco, such data is lacking in Mauritania; anti-HCV was detected in 1.1% among blood donors . It has The epidemiology HCV among the Maghreb countries was found to be variable, and around one million and half people were infected. It is less prevalence among the Tunisian population, followed by Libya with low prevalence, then Algeria and Mauritania which are classified as moderate and later Morocco with a higher prevalence; furthermore HCV genotype 4 is the predominant one among Libyans, though genotype 1 is more common in the rest of Maghreb countries. However, it was difficult to explain such variation as the people in these countries are very interacted and sometimes difficult to differentiate between. This may be related to the nature of the studies we referred to, and hence then, further detailed studies are needed. The epidemiology of HCV among Arabs is unique in its nature, and varieties of risk factors have been found to be associated with its high prevalence rate. However, the emphasis on these factors may vary from one country to another as shown in  HCV has been known to be the most common blood-borne virus over the world particularly among the developing countries. Blood and blood products remain a major cause of spread of HCV among Arab countries, and most of them fail to fulfill the criterions of modern blood transfusion system. Different studies have shown the impact of blood transfusion on the status of HCV in these countries. Studies from Jordan showed that HCV infection was detected in 34% of patients who had received blood transfusion, compared to only 16% of those who received no transfusion . The pic In Arab countries, blood transfusion is still a problem due to the lack of organized infrastructure and highly trained and qualified staff. The main sources, of blood donation are usually relatives and friends of the patients who come on social pressure and due to the fear of the death of a patient (i.e. relative). Donors usually come in emergency time, and questions about high-risk behaviors are seldom asked . TherefoThe current data indicate that all the Arab countries undertake anti-HCV screening mandatory in all blood banks, though in some countries, patients may have to pay for such tests. The main concern is the reliability of such tests, and some data indicated that antibody tests for HCV genotypes/subtypes common in Europe and North America are not well applicable on the sera tested from developing countries though most of Arab countries import such tests . Further The recent uprising in Arab countries which may brought inspiration to Arab citizens left some of health care services in a chaotic situation. In Libya, such crises left an estimated 50.000 killed and over 120.000 injured; screening of blood in war field was mainly limited quick screening tests and sometimes only matching blood groups to save lives . This wi Blood transfusion and hospital-associated practice were found to be important risk factors for HCV among Arabian countries. These conditions can be overcome by development of a fair and organized system of blood screening and transfusion. National and international standards should be implemented, and firm revision for such standards and its implantation should be regularly revised. Further, independent or even legal bodies should observe that such implantation and legal action should be taken. The prevalence of HCV among haemodialysis patients varies greatly from one region to another, and it has been reduced drastically over the years in developed countries. In Japan and UK, it was found to be (1.2%) and (4%), respectively, though in certain African countries, it reached up to 80% as in Senegal . Among AIn Arab countries, blood transfusion has played an important role in transmission of HCV in HD patients. Furthermore, dialysis centres are usually overloaded with patients, and there is a shortage of material support (filters), which leads to multiple use of the filter without proper sterilization in some cases. In addition, there is an insufficient number of dialysis machines; the number of patients dialyzed per machine is twice that in developed countries. Clusters of HCV infection have been noticed in many haemodialysis centres as in Syria, Sudan, Morocco, Yemen, Kuwait, and Bahrain which may suggest large outbreaks in such centres due to patient-to-patient transmission via HCWs' hands . FurtherHepatitis C virus in plasma remains viable and detectable after drying and environmental exposure to room temperature for at least 16 hours; therefore, blood-contaminated surfaces and objects can serve as sources for HCV transmission. Generally, such transmission among haemodialysis units is considered to be nosocomial with possible factors being failure to disinfect devices between patients; sharing of a single-use vials of infusions; poor sterile technique; poor cleaning of dialysis machines; poor distance between chairs in addition to dialyser reuse, duration, and frequency of dialysis . HCV can Transmission of HCV was strongly associated with intravenous and percutaneous drug users (IDUs). The hepatitis C European network for cooperative research group reported a prevalence of HC of 80% among intravenous drug users (IVDU), 40% in Thailand and up to 74% in Australia . In injeInjecting illegal drugs, sex behavior, and imprisonment are considered to be shameful and unrespectable misconduct among Arabian society. Individuals usually hide and deny such act even if they did it, a state to be taken with caution when taking history of risk factors particularly among blood donors. More than a third of all prisoners and more than 80% of injecting drug users, were positive for antibodies to hepatitis C virus . Alcohol Such behaviors are significant factors for HCV infection, and this may become one of the prison system major health concerns over the next two decades. Suggesting that measures to minimize the spread of hepatitis within these groups are essential and education programs seem to be most appropriate way to minimize such risk . This em Hepatitis C virus has been known to be an important nosocomial pathogen, and several outbreaks have been linked to breaches in standard precautions for blood-borne infections during nursing procedures or interventions such as colonoscopy surgery and dialysis . In ArabThe occupational transmission was better studied and the picture was more obvious in the North African region. In Libya, the commonest predisposing factor reported was mainly medical-related transmission of HCV, such as hospitalization and/or surgical procedure risk which accounted for 33%, and history of dental procedure for 15.5%, when compared with other risk factors . The pre In Tunis, 51% of HCV cases were reported to be nosocomial rather than transfusion related. In Algeria, occupational exposure seems to be an important risk factor for HCV transmission . Needle The assessment of sharps use in Arab countries indicates that injections sometimes were given in a way that may harm the patient. Determinants of these unsafe injection practices include the lack of single-use injecting devices, the lack of awareness of the risk of HCV and HIV infection associated with unsafe injections, and the absence of sharps waste management . Infecti Community has been considered to be an important source for hepatitis C, and up to 50% of individuals deny exposure to any of these known risk factors where, infection is often designated as community acquired. Different habitual and biosocial behaviors have reflected on the endemicity of HCV among Arab countries. Indeed children and young adults in Arab countries have a relatively high HCV prevalence, although it is less than in the older population, which suggests that HCV transmission continues in these communities . A varieHabitual and social behaviors have been found to influence HCV infection in Arab countries. Circumcision, one of the potential culturally influenced exposures to HCV in the community, occurred too frequently. Males over the age of 20 had been circumcised either by informal health care providers or by community physicians or nurses who were more likely to be infected with HCV than those circumcised by surgeons , 90. IntIndeed, the status of HCV among Arabic countries should be a worrying issue to all sectors involved in public health, particularly those who are in close contact with patients and strategists who should plan for new healthy look of the Arabic societies , despite Specific prevention programs should take place by adapting better cleansing and standard sterilization methods to stop nosocomial and iatrogenic transmission of HCV. Patient-care practices associated with higher HCV prevalence among chronic hemodialysis units should be identified, and recommendations and precautions in these settings should be adapted. This includes routinely wearing gloves; restricting the use of common supplies, instruments, and medications for multiple patients; prohibiting the use of mobile carts within treatment areas to store or distribute medications and clean supplies , 96. Further programs should include obligatory advanced laboratory screening methods for blood and blood products and reduction of number of transfusion-related transmissions and promote judicious injection and parenteral medications among doctors and patients. Once patients are found to have hepatitis C, they need to be counseled and clinically evaluated, to reduce the risk of transmission and stop the progression of the disease, respectively. Patients with chronic HCV are susceptible to HAV, or HBV infections should be vaccinated particularly among the Arab countries as the prevalence of these two viruses is high . Further≈6.9/1,000 persons per year, indicative of possibly ongoing hyperepidemic transmission in this region [ Hepatitis C virus is a serious ongrowing problem in Arab countries, and it has great social-economic impacts which may touch the future of the young generation and influence the infrastructure of such dynamic states. Despite the great capital and natural resources that this nation has, none of these countries have shown meticulous and clear national or regional scientific plans to combat the future damage that HCV may cause. Prevalence of HCV is destined to increase further among Arab countries which should be an alarming issue for further measures. A recent forecast modeling study for prediction of hepatitis C seropositivity among Libyans has shown that in 2020 the HCV will increase by threefold . Anothers region . This wi


Beilstein Journal of Organic Chemistry is currently attempting to achieve the same impact within chemistry publishing. A Beilstein Thematic Series on Organocatalysis therefore appeared to be quite logical. A brilliant opportunity arose in the context of a priority program sponsored by the Deutsche Forschungsgemeinschaft (DFG), which has in the meanwhile supported the organocatalysis research of over thirty groups in Germany between 2004 and 2010. The series in hand serves as the final report of this highly productive and successful “DFG Organokatalyse Schwerpunktprogramm, SPP 1179”. In addition, it captures the latest research activities in organocatalysis from many of the leading groups from all over the world.During the past 12 years or so, hardly any other field has impacted the art and science of chemical synthesis more profoundly than organocatalysis. The growth, both in academic research and in industrial use, has been breathtaking. Judging by the development of its impact factor, the Organocatalysis describes catalysis with low-molecular-weight organic compounds, in which a metal is not part of the active principle. Organocatalysts donate or remove electrons or protons as their activation mode, hence defining four distinct subareas: Lewis base and Lewis acid catalysis on the one hand, and Brønsted base and Brønsted acid catalysis on the other hand. There are additional aspects that belong to the field and that are being actively researched, including supported catalysts, organocatalysis in unusual reaction media, and applications in polymerizations, in total synthesis and drug-discovery, as well as in drug manufacturing, among many others. Potential advantages of organocatalysis have been emphasized on various occasions and will not be repeated here as such statements are becoming more and more inaccurate generalizations in light of the diversification and growth of the field. Suffice to say here that organocatalysis has plentiful and complementary reactivity to offer. Indeed, certain things that cannot be done with enzymes or metals may well be feasible with organic catalysts.The present Thematic Series serves to showcase the current state of the art of organocatalysis and covers many of the aspects mentioned above. The productivity and creativity of the researchers in the field as such, and of the authors publishing here specifically, is truly amazing. I am highly grateful to all of the many contributors.Ben ListMülheim, August 2012


Background. Lumbopelvic stability (LPS) is regarded as important for injury prevention, yet there are few reliable or valid tests that can be used in the clinical assessment of LPS. Three dynamic functional tests were identified that assess LPS in multiple planes of motion: dip test (DT), single leg squat (SLS), and runner pose test (RPT). Existing rating criteria for SLS have limited reliability and rating criteria for DT and RPT have not been established. Objective. To develop rating criteria for three clinical tests of LPS. Design. Qualitative research: focus group. Method. A focus group of five expert physiotherapists used qualitative methods to develop rating criteria for the three clinical tests. Results. Detailed rating criteria were established for the three tests. Each key factor considered important for LPS had characteristics described that represented both good and poor LPS. Conclusion. This study established rating criteria that may be used to clinically assess LPS. Lumbopelvic stability (LPS) is a highly complex integrated function involving control of many segments of the body . ClinicaIt is important to establish reliable and valid clinical tests as deficits in factors that contribute to a stable lumbopelvic region have consequences for individuals. Deficits in muscle endurance , 5, motoThe ability to properly assess the stability of an individual depends on the formulation of an adequate definition of LPS. Stability of the lumbopelvic region has been described by a number of authors. Bergmark proposed a mechanical engineering description of stability . This stStability of the lumbopelvic region has been described by other authors in broad terms , 19. TheThe purpose of this study was to examine stability of the lumbopelvic region rather than stability of individual segments or within individual segments. However, models of intervertebral stability and intrapelvic stability add to our understanding of regional stability. Panjabi , 21 madeOther researchers have investigated the active muscular and neural stability systems of the lumbar spine making important contributions to understanding the stability of the lumbopelvic region. Desirable patterns of muscle activation of transverse abdominus and multifidus have been described , 25–29. By synthesising the literature in this area, LPS could be defined as the ability of an individual to attain and then maintain optimal body segment alignment of the spine (lumbar and thoracic), the pelvis, and the thigh in both a static position and during dynamic activity. Stability is attained and maintained by passive structures and with optimal muscle recruitment patterns, that is, without substitution strategies. The clinical importance of LPS highlights the need for valid clinical tests of LPS. To examine LPS, it has been recommended that assessment should be performed in an upright position with evaluation of dynamic trunk control over the weightbearing leg, in all planes of motion: sagittal, frontal, and transverse planes . This tyA number of dynamic tests of LPS have been reported in the literature. These include the single leg stand –34, singFor DT and RPT, assessment of performance has been described but there are no agreed rating criteria for these tests. For SLS, rating criteria were used in three studies , 32, 39.Since the three clinical tests lack valid rating criteria, it is not currently possible to use them to reliably assess LPS. Therefore, the aim of this project was to develop clinical rating criteria for the SLS, DT, and RPT for rating LPS.A qualitative research method was used to develop rating criteria for the three tests. Material related to LPS was presented to a focus group of expert physiotherapists, discussion on characteristics of good and poor LPS was held, themes related to assessment of these characteristics were clarified, and rating criteria were qualitatively developed.Five physiotherapists were recruited for a focus group to develop rating criteria for SLS, DT, and RPT. These independent physiotherapists had not participated in the study design and were not authors of this study. The physiotherapists were included as participants if they were accredited as expert musculoskeletal or sports physiotherapists with the national physiotherapy association and were familiar with the use of lumbopelvic stability tests. The physiotherapists were working with sports participants competing at either international or national level in the following sports: gymnastics, softball, track and field, triathlon, or Australian football. They had been practising as physiotherapists for between 6 years and 28 years (mean 14.0 yrs). Approval for the project was obtained from the Human Ethics committee of La Trobe University (application number: 07-136) and informed consent was obtained from all participants. The focus group met for 2 hours to develop the rating criteria. A preliminary discussion schedule of factors that might be indicative of either good or poor performance was presented to the group by the chief investigator, a sports physiotherapist with 26-year experience. This schedule included the above definition of LPS, the protocol for performing the three tests, and abnormal movement patterns of the trunk, pelvis, and hip in all three planes. The chief investigator was familiar with the LPS literature, had developed the definition of LPS, and facilitated discussion within this framework. The focus group was asked to develop criteria that would clearly rate a performance of SLS, DT, and RPT as good or poor on a three-point rating scale with an intermediate category of neither good nor poor . The groThe discussion, recorded in written notes, was read back to the group immediately for further consideration and clarification of the key stability themes. Time was allowed for discussion of the themes with contributions from each member. The themes were divided by the group into separate factors important for stability with representative characteristics of both good and poor stability. The factors and characteristics were confirmed by the group. To enhance rigour and trustworthiness , the ratAgreement was reached by the focus group on rating criteria for the three tests Tables , and 3. Each of the key factors for the tests had descriptive performance characteristics that represented both good and poor stability. The combination of performance characteristics would be used to rate an individual's LPS on each of the tests. A clinical rating would be based on whether an individual predominantly had good performance characteristics or predominantly poor performance characteristics. If an individual did not clearly fit into either of these two categories, then they would be rated as having neither good nor poor stability. The combined performance characteristics would identify the LPS of an individual in one of three categories: good, poor, or neither good nor poor LPS.This study used qualitative methods to develop detailed rating criteria for three clinical tests of LPS: single leg squat, dip test, and runner pose test. This is the first time that detailed rating criteria have been developed for DT and RPT. Use of a focus group to develop rating criteria for the tests of LPS was a pragmatic way to collect views of a sample of expert physiotherapists. This method was chosen for two reasons. First, it was a method that could draw on the interaction within the group to enhance the results, making them more dynamic than the results that might be gained by the use of individual interviews or questionnaires . Second,To ensure the integrity of the results of qualitative studies, it is important that the phenomenon being studied is presented accurately . The defTo develop rating criteria, a pool of potential variables should be considered as the first step . The rigThe second step in the process of developing rating criteria is to decide the final variables to be included . This waA third step in the development of rating criteria has been described as giving a relative weighting or emphasis to the final items included . This waThe trustworthiness of a qualitative research process relies on credibility . CredibiThe trustworthiness of a qualitative research process also depends on transferability , whetherQualitative focus group studies have some disadvantages and these are acknowledged as limitations. Disadvantages relate to the role of the facilitator, accurate recording of the discussion, and management of issues of dissent . First, The present study has developed detailed rating criteria that may be used by clinicians to rate the LPS of individuals using three clinical tests. Single leg squat, dip test, and runner pose test each have key factors that are important in the assessment of LPS. Performance characteristics of good and poor LPS have been identified. In terms of a clinical reasoning process, it is likely that an intervention to address the LPS of an individual rated as having poor LPS would be a priority. Intervention would be less of a priority for those rated as having neither good nor poor stability and may be unnecessary for those rated as having good LPS.


Universities in Cameroon are playing an active part in HIV/AIDS research and much of this research is carried out by students, usually for the purpose of a dissertation/thesis. Student theses/dissertations present research findings in a much more comprehensive manner and have been described as the stepping-stone of a budding scientist’s potential in becoming an independent researcher. It is therefore important to verify how students handle issues of research ethics.Theses/dissertations on HIV/AIDS that described research studies involving the use of human research participants were screened to verify if research ethics approval and informed consent were obtained and documented. The contents of the consent forms were also qualitatively analyzed.Of 174 theses/dissertations on HIV, ethics approval was documented in 17 (9.77%) and informed consent in 77 (47.83%). Research ethics approval was first mentioned at all in 2002 and highly reported in the year 2007. Evidence of ethics approval was found for the first time in 2005 and informed consent first observed and evidenced in 1997. Ethics approval was mostly reported by students studying for an MD (14.01%) and was not reported in any Bachelors’ degree dissertation. Informed consent was also highly reported in MD theses (64.58%) followed by undergraduate theses (31.58%). Voluntary participation and potential benefits of the study were some of the common aspects dealt with in most of the consent forms. The right to discontinue participation in the study and management of residual samples were scarcely ever mentioned.Overall, and given the current state of the art of research ethics around the world, student-scientists in Cameroon would seem to be merely kidding with research ethics. It is thus essential that training in health research ethics (HRE) be incorporated in the curriculum of universities in Cameroon in order that the next generation of scientists may be better equipped with thorough knowledge and practice of HRE. This, we believe, would be one way of fighting the occurrence of research scandals, which have not yet abated significantly, especially those arising from negligence or inexcusable ignorance. HIV/AIDS is a serious public health problem in Cameroon, with the country having an HIV prevalence rate of 5.1% . The fight against the pandemic in Cameroon is multi-sectorial and research institutions, particularly universities and medical schools, are playing an active role through scientific research. In these academic institutions, much of the research is carried out by students, usually for the purpose of a dissertation/thesis. The nature of such research varies and is usually in the biomedical sciences, clinical sciences, epidemiology and behavioral sciences .Compared to journal articles, student theses and dissertations enjoy greater word count allowances and present research findings in a more comprehensive manner. Student theses/dissertations have been described as a stepping-stone and reflection of a student’s potential in becoming an independent researcher ,2. It isThe literature on bioethics in Cameroon has focused primarily on philosophical discussions and opinions -9 and thPrevious studies on research ethics pertaining to student dissertations have been carried out in Sri Lanka , Sweden This is a retrospective descriptive study. Theses/dissertations on HIV research studies, which were available in university libraries in Cameroon, had been collected as part of an anterior study to establish an in-depth bibliography of studies on HIV/AIDS in Cameroon . All theses/dissertations had been collected with the permission of the university authorities. Theses/dissertations describing research carried out in Cameroon but defended in a university out of Cameroon were not included in this study.In the bibliographies, there were two hundred and sixty-one (261) student theses/dissertations on HIV/AIDS in Cameroon. These included theses/dissertations from 24 different universities . The summary/abstract, “material and methods” section of each thesis/dissertation was carefully read and only theses that involved the use of humans as research participants or that reviewed personal medical records found in hospitals and clinics were included in the study.For each thesis, we extracted information on the year the thesis was written, the type of academic degree for which it was written . The theses were further grouped as Bachelor degree, Medical degree (MD) and a postgraduate degree . We checked each thesis/dissertation for a statement on research ethics approval and informed consent and, if available, the name of the REC or IRB from which research ethics approval was obtained. A similar method had been described in previous studies ,19,21. WIf ethics approval and informed consent were reported, we checked for the evidence . For theses/dissertations that included the consent form, we assessed the content of the consent form using a pre-agreed checklist and also as previously described  with somA total of 184 theses/dissertations on HIV/AIDS in Cameroon were included in this study. These theses covered 20 years of HIV research (from 1989 to 2010) from 4 universities in Cameroon . The areas of research varied and included clinical, social science, epidemiological and biological studies. Ten studies (5 in the years 2001–2005 and 5 in the years 2006–2010) did not require research ethics approval, as they did not involve the use of research participants. The analysis of the results on ethics approval therefore excludes these 10 studies. Of the 184 theses/dissertations, 23 studies did not require informed consent, as they either did not involve human research participants or involved only retrospective analysis of medical data/records. In total, 174 studies were included for analysis on research ethics approval, while 161 were included for analysis on informed consent  of the theses/dissertations had a statement on research ethics approval of which 9 52.94%) included a copy of the ethics approval certificate  the Ethics Committee of the Faculty of Medicine and Biomedical Sciences, ii) the Ethics Review Board of the National Medical Council, iii) the National Ethics Committee and iv) the Ethics Review Committee of the Ministry of Public Health.nd 1987) governing health research in Cameroon demands that all health related research studies involving human research participants go through review by a REC. Students therefore need to be sensitized and encouraged to respect at least the basic research ethics procedures, namely, obtaining ethics approval/clearance from a REC before the commencement of a research study, obtaining genuine informed consent from research participants and ensuring confidentiality for people recruited into a study.The results of this study indicate that students in Cameroon universities, involved in HIV-research, are not taking research ethics seriously into consideration when they design their research studies. And they could be said to be only kidding with research ethics even when they do take it into consideration, whereas the research itself they are doing is evidently no child’s play. This might be because they are either not sensitized on the importance of research ethics, are simply not aware of what research ethics is all about, or may be aware of the place and importance of research ethics but have deliberately decided to push it to the background for whatever reasons. It is important for stakeholders charged with university education to note that graduate students and students in medical schools constitute tomorrow’s scientists and therefore need to be properly trained in research methodologies. Such training should include HRE especially for those who are likely to become career scientists or to engage or participate in health related research. If this is done, it can realistically be expected that health research in Cameroon would conform to all the principles of good practice in the domain. Recent empirical studies have shown that researchers in Cameroon significantly failed to document research ethics approval in their publications . ResearcDespite the existence of a regulation that requires the submission of research protocols involving humans as research participants to a REC, and the creation of an ethics committee in Cameroon as far back as 1987, students in Cameroon still systematically failed, throughout the period under review, to obtain/document research ethics approval for their research studies. Only 9.77% of theses reviewed had a statement on ethics approval . This principle is applicable in research by ensuring that informed consent is appropriately obtained from all research participants. In this study, we realized that this principle appeared to be relatively better respected by research students when compared to, say, obtaining research ethics approval/clearance. Amongst the 161 studies that required obtaining informed consent, 47.83% had a statement on informed consent Table . AlthougDocumenting ethics approval and informed consent varied tremendously across the various academic degree types. Most of the theses (14.01%) that had a statement on ethics approval were theses written for a medical degree, while no undergraduate theses documented ethics approval Table . SimilarBased on these results, including research ethics in the postgraduate curriculum is of utmost importance ,23. A prThe Ethics Committee of the Faculty of Medicine and Biomedical Sciences, the Ethics Review Board of the National Medical Council, the National Ethics Committee and the Ethics Review Committee of the Ministry of Public Health were the 4 ethics committees most cited in the theses/dissertations reviewed. This would seem to imply that students do not usually approach the RECs/IRBs in their own universities or faculties for ethics review, or else the RECs/IRBs in these universities might not be functioning properly. Whatever the case, should RECs/IRBs in the universities where students are based not be functioning, it is advisable that students submit their research proposals to the other functioning RECs/IRBs. Students and theses supervisors need to be sensitized and encouraged on the importance of obtaining ethics approval before the commencement of any research study that involves human research participants and/or access to personal medical data. Such sensitization can be achieved through organization of training workshops in HRE for researchers/investigators in Cameroon and the teaching of research ethics in universities.In this study, only 49.35% of the theses reviewed had a sample of the informed consent form that was used for the recruitment of research participants Table  and the I…………. have understood the objectives of this study titled [title] and have accepted freely to be a participant in the study.""Further analysis of the consent forms revealed that explaining the purpose of the study and that confidentiality would be protected were a common aspect in the consent forms, followed by explaining the potential benefits of being part of the study. The right to discontinue participation in the study and the management of remaining study samples were scarcely mentioned in the informed consent forms Figure . This coHealth related research in Africa still faces a lot of ethical hurdles which can be successfully crossed only if capacity building in the continent involves harmonized training of young researchers,  in HRE. Such training should be accompanied by the training of members of RECs. This study demonstrates that students do not seem to consider research ethics, or at least its reporting and documentation, as important, since they significantly failed to report ethics approval and informed consent in their theses, although a slight progressive improvement is observable in the last 5 years. The main reasons for this situation could be that i) there is no systematic training in research ethics in Cameroon universities and ii) supervisors/senior researchers do not appreciate or are not aware of the importance of research ethics and, consequently, fail to mentor their students or trainees appropriately about it or they simply push it to the background. It is therefore essential that training in HRE be incorporated in the curriculum of universities in Cameroon in order to bring up the next generation of scientists equipped with a thorough knowledge and practice of HRE. Also, guidelines for writing student theses should include at least a statement requiring students to show proof of ethics approval in their theses, if the research involves human participants. This, we believe, would be one way of fighting the occurrence of research scandals, many of which probably result from negligence and ignorance rather than from deliberate intention. Equally recommendable is the introduction of standardized continuous education and refresher courses in research ethics for both junior and senior researchers in Cameroon. If such measures are not put in place, the country surely runs the risk of documenting more research scandals in the nearest future.The authors declare that they have no competing interests.NSM conceived the study, participated in the design of the study, collection and analysis of data and drafting of the manuscript. GBT participated in the design of the study, analysis of the data, coordination of the study and drafting of the manuscript. CPC was involved in the design of the study, collection of data, analysis of data and in drafting the manuscript. LV was involved in study design, analysis of data and drafting of the manuscript. OOMOB participated in the design of the study and coordination, data collection and analysis, and the writing of the manuscript. All authors read and approved the final manuscript.The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6939/13/12/prepub