Background A food ladder is a step-wise progression from extensively heated to unheated food. Heating decreases the allergenicity of food proteins by modifying conformational epitopes. Progressing from extensively baked to less heated foods offers a progression from a less-allergenic to a more-allergenic form. Currently available food ladders lack standardization and often lack recipes and clear instructions, and nutritional content and palatability are not always considered. Objective We have created an egg ladder (EL) for IgE-mediated egg allergy. Methods We adapted toddler-friendly recipes to create an EL with seven steps of progressing egg protein content. The proteins were quantified by Multiplex Array for Indoor Allergens (MARIA) for Foods analysis for ovomucoid and ovalbumin via “Neogen’s Veratox® for Egg Allergen” for total egg allergen protein content. Results Our EL considers age-appropriate foods, allergen content, ease of preparation, and nutrition. Each step includes several recipes with comparable amounts of protein. Standardization of the EL recipes by quantifying allergenic protein content demonstrated that the progression of foods varies based on which component was used to rank. We elected to use a weighted ranking based on Gal d 1, Gal d 2, and total egg protein values for our final ladder. Conclusion An EL can potentially be an effective management option for IgE-mediated egg allergy. Further work is needed to determine whether our EL is efficacious and safe for widespread use in IgE-mediated egg allergy and if a patient’s sensitization profile should play a role in the order of the ladder foods chosen.

Trends and Disparities in Ventricular Tachycardia-Related Mortality According to Cardiomyopathy Type in the United StatesMohammad Ali Sheffeh, M.D1-2., Jeanne du Fay de Lavallaz, MD3., Andres Estrada Magana, M.D2., Konstantinos C. Siontis2, MD Jackson J. Liang, D.O31 Department of Internal Medicine, Henry Ford Warren Hospital, Warren, MI, USAMsheffe1@hfhs.org2 Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN, USA estradamagana.andres@mayo.edu, Siontis.Konstantinos@mayo.edu3 Department of Clinical Electrophysiology, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USAdufaydej@med.umich.edu, liangjac@med.umich.edu

Although major investigations on the AF risk after AFL ablation have been published, the natural history of right AFL after cardioversion is much less understood. The authors sought to the largest historical cohort on the subject in order to establish the true risk of AFL and AF recurrence after AFL DCCV. Overall, 860 individuals with atrial arrhythmias were included and underwent their first DCCV. The median time to recurrence was 3.4 months in the AF cohort (n=572), and 1.7 years in the AFL cohort (n=288). The overall recurrence of atrial arrhythmias was 96.0% for the AF group and 78.8% for the AFL group (p<0.001). In the AF group, most of the recurrent rhythm was AF (92.7%), while only a small percentage was AFL (7.3%). Conversely, the AFL cohort showed recurrence of AF in only 32.6% of cases and 67.4% reverted back to AFL. AFL recurrences represented 53% of the cases within the entire AFL population. the authors created a clinical predictive risk score for predicting recurrence risk after the first DCCV in this pure AFL population. the REAL-PDX risk score stratified by ≥3 vs. <3 in the AFL validation cohort (n=112) showed a significantly shorter median time to recurrence (125 vs. 800 days; p<0.001) and a higher risk of recurrence of atrial arrhythmia (HR: 3.74; 95% CI [1.93-7.24]).This study will certainly remain a benchmark in the field of right AFL natural history after DCCV.

Background: Juvenile xanthogranuloma (JXG) is a rare non-Langerhans cell histiocytosis that typically presents as self-limiting cutaneous lesions in infants and young children. However, systemic involvement can lead to severe organ dysfunction and poses significant therapeutic challenges. Case presentation: We report a case of chemotherapy-refractory, multisystem JXG harboring BRAF V600E mutation in a 28-month-old male. The patient presented with recurrent fever, bilateral orbital involvement, and progressive multisystem infiltration without cutaneous lesions. First-line chemotherapy failed to control disease progression and was complicated by pulmonary infection. Oral dabrafenib monotherapy induced rapid clinical and radiologic remission, with clearance of BRAF V600E in peripheral blood cell-free DNA . The patient has maintained remission for four years, including two years off-therapy. Conclusion: This case demonstrates durable remission with dabrafenib in BRAF-mutant systemic JXG and highlights the potential of BRAF-targeted therapy as an effective and safer alternative to conventional chemotherapy in refractory cases.

In the accelerating global biodiversity crisis, it is imperative to document biodiversity patterns along with their underlying drivers. To support this, ecological studies must identify the processes driving species distributions. Our objective was to study how benthic community variability is structured across spatial scales, and how fine-scale patchiness contributes to larger scale biodiversity in the Western Antarctic Peninsula. Using underwater imagery, we quantified benthic community composition at different scales using a nested sampling design. We used cluster analyses (NMDS, SIMPROF and SIMPER analysis) to detect patterns in benthic community variability. NMDS showed that seemingly different stations had many similar images. Images were clustered according to their community composition into 31 signifcant clusters, or microhabitat types, which were not divided by geographic location, substrate type or macroalgal cover, like initially presumed. Instead, the differences in faunal assemblage seem to be influenced by the dominant macroalgae species and biogenic habitat complexity. All in all, we found that these microhabitats emerge as ecologically meaningful units that offer a practical scale at which to detect patterns and early ecological shifts. Changes in the distribution or frequency of these microhabitats may occur before shifts in species composition become detectable at site or station level, which is crucial for ecosystem monitoring.

A document by Douglas Jones. Click on the document to view its contents.

Introduction:Infective Endocarditis (IE) is the result of an established focus of infection in the heart affecting its innermost lining, the endocardium. Despite the significant advances made over the past year in medical treatments and surgical interventions it remains a significant challenge for clinicians as its mortality rate has not changed over 2 decades [1,2]. Its complications, ranging from abscess formation, valve destruction, embolic events, hemodynamic disorders and heart failure, to name only a few, can be potentially disastrous and involve every organ system [2, 3, 4]. In developed countries, Staphylococcus aureus is the leading microorganism incriminated followed by Streptococci and various other pathogens such as enterococci [2]. Streptoccusgordonii is a gram-positive, unencapsulated organism that is a commensal of mucosal surfaces and skin in humans. It has been implicated in a wide variety of opportunistic infections, both in systemic and local diseases, such as septic arthritis, periodontitis, abscesses, peritonitis but rarely reported as a causative agent of endocarditis [5].Herein, we will expose the case of a man who presented with an embolic stroke. After an extensive workup he was found to have a Streptococccus-gordonnii associated endocarditis. The detailed clinical scenario and therapeutical approach is discussed.

A document by Mohamad Fael. Click on the document to view its contents.

Satellite-derived vegetation indices (VIs) provide a powerful means to quantify habitat variation in long-term ecological studies, but their reliability as proxies for forage availability in wild herbivore populations remains underexplored. We used three decades of Landsat satellite imagery (1991–2023) to generate a 30m resolution dataset of a proxy measure for annual vegetation greenness – the Normalized Difference Vegetation Index (NDVI) – for the Isle of Rum, Scotland, home to a long-term study of wild red deer (Cervus elaphus). We validated the NDVI data against field-collected vegetation biomass data and compared it with a coarser-resolution (500m) MODIS Enhanced Vegetation Index (EVI) metric. Landsat NDVI was positively correlated with both biomass and EVI, supporting its ecological relevance as a measure of forage availability. All three metrics have increased over the last three decades, indicating a long-term greening trend, with the higher resolution Landsat dataset revealing a variation in the rate of change among vegetation types, including grassland habitats preferred by deer. These findings suggest an increase in foraging availability over time and offer a possible mechanism underpinning observed demographic shifts, such as earlier calving. Our approach provides a transferable framework for integrating satellite data with individual-based field studies, demonstrating how remote sensing can enhance ecological inference in long-term wildlife research.

Combined Treatment of Myofascial Pain Syndrome by Bilateral Coronoidectomy and Botulinum Toxin Injection

Several lines of evidence suggest a feasibility to define the SCR-related EEG activity. The problem of the precise time localization of the SCR-related oscillations (SCR-ROs) has been resolved through computational dealing with the SCR signal itself and taking into account the variability of latency of the SCR. The SCR-ROs have been identified as delta-frequency EEG activity with an initial deep negative deflection. The thesis about the existence of the SCR-ROs has been tested through a computational modeling study applying the system identification approach considering the SCR-ROs as the output of the system. The study involved 20 participants and the stimuli for the elicitation of the SCR were slide presentations of short stories from the contemporary literature. Single-trial SCR-ROs have shown convenient for the system identification modeling approach. The EEG epochs were 1.5 seconds long and delays between the SCR-ROs and the respective SCRs were 0.7-4.0 seconds. Obtained values of the system parameters in the whole sample of the single-trial based models of the SCR-ROs have a modest variability. Validity of the concept of the SCR-ROs was tested by a Monte Carlo analysis at the level of each participant. The difference in average, median, and maximum value of the model fit in the system identification modeling between the true, SCR-ROs and fake EEG epochs were significant at the level p<0.001 in the sense of better fit in the true SCR-related epochs in 17 participants and in 3 subjects the significance reached the level of p<0.05. The result points to a causal link between the signals of the SCR system and the related delta-EEG fluctuations, contributes to the validity of the concept of the SCR-ROs, and suggests possibility for a psychophysiological observability of the neural system which is shared by processes which generate both the SCR and the SCR-ROs.

Infanticide by females occurs in many mammalian species but is rarely observed directly, making its social and ecological determinants difficult to identify. Here, we report the first direct observation of within-pack infanticide by a female free-ranging domestic dog. To assess whether this case can be better explained by resource competition or nutritional gain, we examined the social context in which it occurred. In our long-term study population, we identified 26 cases characterised by a similar pattern of overlapping pregnancies within social groups. By comparing dominance rank and birth order across cases, we found that subordinate females time their births after or in synchrony with the alpha female, which may be a strategy to reduce infanticide risk. By giving birth later, the subordinate potentially allows the alpha a competitive advantage, thereby reducing the incentive for infanticide. Furthermore, subordinate free-ranging dogs may use communal denning as a protective measure, as it hinders the identification of individual litters. In our study, the infanticide followed a period of rank instability. Social rank instability could elevate infanticide risk, since the absence of dominance signals might complicate the subordinate's assessment of the potential threat to its offspring, or because infanticide is used to consolidate dominance. On the other hand, we did not find support for the hypothesis that insufficient nutrition motivated the infanticide, based on an evaluation of the body condition scores within the pack and on the observation that not all killed pups were eaten. Taken together, our findings suggest that resource competition rather than nutritional gain may better explain infanticide by female free-ranging dogs.

Objective To evaluate whether prenatal exposure to opioids analgesics is associated with poor academic performance in third grade children. Design: Population-based cohort study using linked data from New South Wales birth records, medicine dispensing data, and national standardised test results. Setting: New South Wales, Australia (2003-2011). Population: Liveborn children of concessional women, excluding those whose mothers lived interstate, were overseas visitors, or had records of opioid dependence. Methods: Exposure was defined as ≥1 opioid dispensed during pregnancy stratified by pregnancy timing, dose, and type of monotherapy. Reading and numeracy z-scores were compared between children with and without prenatal opioid exposure using linear mixed-effects models incorporating propensity score weights, and accounting for maternal and school clustering. Main Outcome Measures: Standardised national reading and numeracy Z-scores for third-grade children. Results Among 85,478 eligible children, 70,882 (82.9%) had test scores, with 7,664 (10.2%) prenatally exposed to opioids analgesics, mainly codeine. Compared with unexposed children, differences in mean z-scores were small for reading and numeracy among children with any prenatal opioid exposure (adjusted β [aβ] -0.05, 95% CI -0.06 to -0.03 for both). Results for codeine and oxycodone were similar, but a greater difference was observed for tramadol (reading aβ -0.25, 95% CI -0.31 to -0.18; numeracy aβ -0.22, 95% CI -0.29 to -0.16). Conclusions Prenatal exposure to codeine and oxycodone do not have meaningful impacts on third-grade academic performance. It is unclear if the lower academic performance observed with tramadol exposure is attributable to unmeasured confounding or a true effect, warranting further investigation.

As habitats change, animal-mediated seed dispersal increasingly depends on how animals respond to altered habitat structure and resource availability. With habitat loss and degradation accelerating across the tropics, understanding how animal movement influences distance- and density-dependent seed mortality is key to promoting forest regeneration. Across a gradient of anthropogenic disturbance in a tropical lowland landscape of southeast Mexico, we assessed how the movement patterns of black howler monkeys (Alouatta pigra) influence their seed dispersal services through GPS tracking, behavioral observations, and seed sampling. Given the species’ long gut transit time, we employed a path analysis to examine how movement patterns across spatiotemporal scales directly and indirectly shape seed dispersal distance. By dispersing seeds away from the parent plant at an average distance of 99.5 ± 64.4 m, black howler monkeys likely reduce mortality risks associated with distance- and density-dependent effects. At the smallest scale, step lengths and relative turning angles emerged as key predictors of seed dispersal distance, revealing that goal-oriented movement strategies may enhance their ecological role as seed dispersers. At broader scales, variability in weekly core area size, driven by resource availability, strongly influenced seed dispersal distance. However, low availability of fruiting trees in disturbed areas may limit the black howlers’ ability to support natural forest succession. Ultimately, our findings show that animal responses to human habitat disturbance can influence key processes like seed dispersal, potentially affecting forest regeneration and ecosystem resilience, highlighting the need to understand these dynamics to predict and manage long-term impacts of disturbance on biodiversity and ecosystem function.

Determining which statistical methods are appropriate for data is both user and data dependent and prone to change as new methodology becomes available. This process encompasses model ideation, model selection, and determining appropriate use of statistical methods. Literature on models for animal movement emerging in the past two decades has yielded a rich collection of statistical methods garnering much deserved positive attention. Among such efforts, there is limited investigation of the broader place for simple machine learning methodology in animal movement modeling. We propose a bagged (i.e., bootstrap aggregated) animal movement model using simple, off-the-shelf machine learning algorithms. The model is intuitive, retains statistical inference about characteristics of animal movement (i.e., estimated from model-based summary statistics), and only requires knowledge of elementary statistical and machine learning analysis to understand. We show by simulation that our model can provide unbiased estimates of pertinent characteristics of animal movement (e.g., daily displacement) in the presence of large and realistic location error. We believe that increasing accessible literature on simple machine learning animal movement models provides valuable pedagogical and practical support for researchers using statistical models to study animal movement.

Real-World Feasibility and Challenges in Using LAS for Stress EchocardiographyDear Editor,Fitzgerald et al. (2025) investigate left atrial strain (LAS) in stress echocardiography to evaluate diastolic dysfunction and myocardial ischemia. This critique examines the unaddressed methodological gaps that affect the reliability and clinical utility of LAS. [1]The study neglects to assess inter-observer and intra-observer variability in LAS measurements, despite using semi-automated speckle-tracking echocardiography with manual adjustments. This omission undermines claims of LAS reproducibility, as operator variability could compromise measurement consistency across clinical settings. Edwards et al. (2024) showed that novices produce less consistent LAS measurements than experts [2]. Ha et al. (2020) noted that variability in echocardiographic techniques can affect diagnostic reliability [3]. Cameli et al. (2016) highlighted that operator-dependent factors impact LAS reproducibility, critical for clinical adoption [4]. Without such data, the study’s findings lack robustness for universal application.The study assumes abnormal LAS responses indicate elevated LA filling pressures or dysfunction but lacks invasive validation (e.g., LA/LV pressure measurements). This speculative physiological basis weakens LAS’s validity as a diagnostic marker. Invasive measurements are crucial to confirm diastolic dysfunction or ischemia. Ha et al. (2020) emphasized invasive validation for non-invasive markers like LAS [3]. Cameli et al. (2016) stressed invasive correlation for LAS’s clinical utility [4]. Edwards et al. (2024) noted that unvalidated assumptions about echocardiographic markers limit their diagnostic reliability [2]. This gap hinders LAS’s clinical applicability.While Fitzgerald et al.’s work offers valuable insights into LAS in stress echocardiography, addressing observer variability and incorporating invasive validation would strengthen reproducibility, enhance physiological validity, and improve its potential for broader clinical application.References1. Fitzgerald, B.T., Chan, J., Lam, A.K. and Scalia, G.M. (2025), Assessing the Use of Left Atrial Strain Before and After Treadmill Exercise Stress Echocardiography. Echocardiography, 42: e70253. https://doi.org/10.1111/echo.702532. Edwards NF, et al. The Learning Curve for Left Atrial Strain Analysis. Journal of the American Society of Echocardiography. 2024;37(10):1014–1016.3. Ha JW, et al. Diastolic Stress Test: Invasive and Noninvasive Testing. JACC Cardiovascular Imaging. 2020;13(1 Pt 2):272–292.4. Cameli M, et al. Left Atrial Strain: A New Parameter for Assessment of Left Ventricular Filling Pressure. Heart Failure Reviews. 2016;21(1):65–76.Author detailMuhammad Mudasir AtifAffiliationJinnah Sindh Medical University

Labridae (wrasses and parrotfishes) is one of the most ecologically diverse families of reef-associated fishes but remains underrepresented in mitochondrial genomic resources. The availability of complete mitochondrial genomes is critical for both evolutionary and ecological research, since they are increasingly being used across population genetic, phylogenetic, species identification and eDNA studies. A low-cost method to increase mitogenomic representation is to leverage off-target reads produced in target-capture sequencing (TCS). Here we use a recently published ultraconserved elements (UCE) dataset for Labridae to assemble and annotate off-target reads to produce complete mitogenomes for 68 species within Labridae, 54 of which are novel to NCBI. These novel complete mitogenomes expand the taxonomic coverage of labrid mitogenomes from less than 5% and 12% to 13% and 20% on NCBI’s RefSeq and Nucleotide databases. We also recovered partial mitogenomes for a further 191 species in the family. Comparative analyses revealed that the lengths of the mitogenomes varied between 16,320 and 17,288 bp. While protein-coding genes (PCGs), rRNAs and tRNAs exhibited little variation, the D-loop showed notable length variability, consistent with trends observed in other fish lineages. Comparisons among labrid tribes highlighted Cirrhilabrinae as having the longest mitogenomes (average=17.2 kbp), while Julidinae displayed the broadest size range (16.3-17.1 kbp), likely due to its higher species richness and representation in the original UCE dataset. Phylogenetic reconstruction using all 13 PCGs and two rRNAs confirmed the eight-tribe topology previously seen within Labridae, each with strong nodal support. Although some topological discordance was observed when compared to previously published labrid phylogenies (e.g. the placement of tribe Cirrhilabrinae) systematic relations are relatively consistent with previous phylogenies of the family. These results significantly expand the mitogenomic representation within Labridae, providing a valuable resource for future phylogenetic and evolutionary studies in this family of reef fish. It also highlights the additional value that can be gained from off-target reads of TCS data.

A CRITIQUE ON MATERNAL INSANITY– A CASE OF POSTPARTUM PSYCHOSIS AND INFANTICIDE