Attacks on healthcare facilities as an indicator of violence against civilians in Syria: An exploratory analysis of open-source data.

BACKGROUND: Grasping the human cost of war requires comprehensive evaluation of multiple dimensions of conflict. While the number of civilian casualties is a frequently used indicator to evaluate intensity of violence in conflict, the inclusion of other indicators may provide a more complete understanding of how war impacts people and their communities. The Syrian conflict has been specifically marked by attacks against healthcare facilities, and the advancement of technology has provided an avenue for remote data analysis of conflict trends. This study aims to determine the feasibility of using publicly available, online data of attacks on healthcare facilities to better describe population-level violence in the Syrian Civil War. METHODS: This study utilized publicly available datasets from the Violations Documentation Center (VDC) and Physicians for Human Rights (PHR) to compare trends in attacks on healthcare facilities and civilian casualties from March 2011 to November 2017 in the Syrian Civil War. We used descriptive statistics, bivariate tests and a multivariable hypothesis testing model to measure the association between the two indicators while adjusting for confounding variables. RESULTS: We examined for associations between attacks on healthcare facilities and overall civilian casualties. In the adjusted regression model, each attack on a healthcare facility in the Syrian conflict corresponded to an estimated 260 reported civilian casualties in the same month (95% CI: 227 to 294). This model adjusted for population displacement (using number of registered refugees as a proxy). The May 2014 interaction term, used a transition point of early/late war based on political events during that time, illustrated that each healthcare facility attack after May 2014 corresponded to a statistically significant decrease of 228 civilian deaths. This suggests that although attacks on healthcare facilities continued to contribute to overall civilian deaths, the scale that this was happening was lower after May 2014. CONCLUSION: In the Syrian Civil War, our findings suggest that the inclusion of other humanitarian indicators, such as attacks on hospitals, may add granularity to traditional indicators of violence (e.g. such as civilian casualties) to develop a more nuanced understanding of the warring tactics used and violence against civilians in the Syrian conflict. This exploratory case study represents a novel approach to utilizing open-source data along with statistical analysis to interpret violence against civilians. Future research could benefit from analyzing attacks on healthcare facilities and other civilian infrastructure concurrently with civilian casualty data for further data-driven utilization of open-source data.

Y-box protein 1 is required to sort microRNAs into exosomes in cells and in a cell-free reaction.

Exosomes are small vesicles that are secreted from metazoan cells and may convey selected membrane proteins and small RNAs to target cells for the control of cell migration, development and metastasis. To study the mechanisms of RNA packaging into exosomes, we devised a purification scheme based on the membrane marker CD63 to isolate a single exosome species secreted from HEK293T cells. Using immunoisolated CD63-containing exosomes we identified a set of miRNAs that are highly enriched with respect to their cellular levels. To explore the biochemical requirements for exosome biogenesis and RNA packaging, we devised a cell-free reaction that recapitulates the species-selective enclosure of miR-223 in isolated membranes supplemented with cytosol. We found that the RNA-binding protein Y-box protein I (YBX1) binds to and is required for the sorting of miR-223 in the cell-free reaction. Furthermore, YBX1 serves an important role in the secretion of miRNAs in exosomes by HEK293T cells.