Increased frequency and severity of droughts threatens forest health worldwide. Tree species adaptations -- e.g., dry-season deciduousness in tropical seasonal forests -- and individual traits -- e.g., size, crown position -- shape drought resistance, but such resistance may be variable across species, microenvironments, and drought events. Here, we assess growth responses of 1820 trees across 30 species to three climatically distinct droughts in a seasonally dry tropical forest in Western Thailand. Species and individuals exhibited a wide range of growth responses within each drought, and differences in response intensity and affect among the drought events. Deciduous and evergreen species were more sensitive to wet- and dry-season drought respectively. While individuals with more exposed crowns tended to grow less in all droughts, stem diameter and topographic wetness had variable effects. Heterogeneous drought responses of species and individuals indicate potential spatiotemporal insurance effects in diverse forests in the face of increased drought.

Rare Case of Long Retained Button Foreign Body in Esophagus Removed by Esophagotomy: A Case Report from Muhimbili National Hospital, Tanzania.Rajabu Athumani Bakari1,2*, Georvin Marco Haule2, Alfred Chibwae1, Charles Oswald Ruboha1, Diana Batuel Ngulo1, Gerald Mpemba3, Hilda Makungu3, Abdulrahman Abdallah Amin2, Ally Hamisi Mwanga1, Zaitun M. Bokhary2, Kitembo Salum Kibwana2, Charles Komba21 Department of Surgery, School of Medicine, Muhimbili University of Health and Allied sciences, Dar es Salaam, Tanzania.2 Department of Surgery, Muhimbili National Hospital, Dar es Salaam, Tanzania.3Department of Radiology, Muhimbili National Hospital, Dar es Salaam, Tanzania.*Correspondence : Rajabu Athumani Bakari, Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. Tel: +255738297925; E-mail: rogerluhizo@gmail.com

Background: Early intervention in Psychosis (EIP) services are vital in reducing long-term impact of first-episode psychosis (FEP). However, women with FEP encounter unique biological, social and systemic challenges that may delay diagnosis, hinder access to cares and affect treatment engagement. Aims: This study explores clinicians’ perspectives on the sex-specific needs of women with FEP, focusing on hormonal influences, caregiving responsibilities stigma and systemic barriers to care within EIP services. Method: A qualitative design was employed, utilising semi-structured interviews with 20 clinicians from EIP and adult mental health services in Dublin, Ireland. Reflective Thematic Analysis was used to identify key themes, with an inductive constructivist approach underpinning the analysis. Results: Five key themes emerged: (1) Sex differences in presentation, with women showing later onset, higher emotional distress, and lower rates of substance-induced psychosis; (2) Hormonal interactions, highlighting the impact of menstruation, pregnancy, and menopause on symptomatology and treatment response; (3) Shame and adjustment, with internalised stigma, delayed help-seeking, and disruption of social roles (4) Barriers to care, including caregiving responsibilities and inflexible service models. Clinicians emphasised the need for integrated, sex-sensitive, and trauma-informed care, as well as improved collaboration between psychiatry, gynaecology, and endocrinology and; (5) Recommendations for improving care. Conclusions: Women with FEP face multifaceted barriers to accessing and engaging with EIP services. Implementing clinician recommendations namely, flexible and integrated care, trauma-informed and sex-sensitive approaches, and robust cross-disciplinary collaboration is vital for improving outcomes. Future research should incorporate service user perspectives to further refine inclusive and effective EIP pathways for women.

Inclusive assessment is essential in higher education to ensure that all students, regardless of background, ability, or circumstance, have equitable opportunities to demonstrate their learning. In high-stakes disciplines such as pharmacology and medical sciences, where assessment outcomes significantly influence academic progression and professional qualification, embedding inclusive practices is particularly important. Equity, Diversity, and Inclusion (EDI) have emerged as central principles in shaping contemporary educational approaches, especially in how we design and deliver assessments. Integrating EDI into pharmacology assessment is critical for creating learning environments that are fair, accessible, and responsive to the needs of a diverse student body, including individuals from varied cultural and socio-economic backgrounds, those with disabilities, and neurodivergent learners. This review examines the theoretical underpinnings and practical applications of inclusive assessment within pharmacology and related health science disciplines and integrates practical examples to highlight innovative strategies that promote equitable and pedagogically sound evaluation of student learning. In doing so, the paper also acknowledges the systemic and institutional challenges that may impede implementation and proposes evidence-informed, actionable recommendations to address these barriers. The overarching aim is to support educators in advancing inclusive assessment practices that not only foster academic success and fairness but also contribute to the development of a diverse, capable healthcare workforce equipped to navigate the complex health challenges of the 21st century.

Readers frequently skip words, often when they are expected (Staub, 2015), but sometimes even when they are contextually incompatible (e.g., the high frequency article the; Angele & Rayner, 2013). Therefore, some skipping behaviors may be automatic (e.g., based on familiarity or length) rather than based on thorough word identification, raising the question of how related word skipping behavior is to comprehension of the meaning of the text. To test this question, we co-registered eye tracking and EEG recordings and measured fixation-related brain potentials (FRPs). We time-locked FRPs to the pretarget word before a three-letter target word embedded in a high constraint sentence, and compared the neural activity between different preview conditions when the target word was subsequently either skipped or fixated (i.e., behavior-contingent analysis). We used a gaze-contingent display change to manipulate the parafoveal word to be (1) expected, (2) an anomalous orthographic neighbor of the expected word, or (3) an anomalous instance of the, which changed to the expected word during the skip or fixate saccade. We found a parafoveal N400 effect to the anomalous neighbor compared to the expected preview that only occurred when the target was skipped, but not when it was fixated. There was also a parafoveal N400 effect for the anomalous the compared to the expected word that was not skipping-contingent. This pattern demonstrates that word skipping is associated with the depth of parafoveal linguistic processing, but these decisions are initiated prior to complete identification and contextual integration processes, which continue after the eyes have moved on.

AuthorsXinjian Pei¹, Jiuhui Han¹*, Jinchao Cao¹, Junzhong Luo¹, Yunshan Su¹Affiliation¹Department of Pediatric Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, ChinaCorresponding AuthorJiuhui Han Email: 15227178851@163.com

Moyamoya disease in an eight years old female child -- A case report

1. IntroductionLymphoma of the thyroid gland constitutes 3% of all non-Hodgkin’s lymphoma and 5% of all thyroid malignancies. Autoimmune disease, including systemic lupus erythematosus, increases the risk of lymphoma, (1-2) in particular, the risk of developing thyroid lymphoma in patients with Hashimoto’s thyroiditis is 40 to 80 times greater than that of the general population. (3) The incidence of pre-existing autoimmune thyroiditis or Hashimoto’s thyroiditis in patients with thyroid lymphoma has been reported at 27-100% in previous studies. (4-6) Diffuse large-cell lymphoma is the most common type of thyroid lymphoma. Patients usually present with a rapidly growing mass in the neck, causing local obstructive and infiltrative symptoms such as hoarseness, dysphagia, or dyspnea. Review of the histopathology reveals lymphoid cells that can be difficult to distinguish from autoimmune thyroiditis which can cause misdiagnosis due to the low yield of fine needle aspiration. We present a rare case of primary thyroid diffuse large B cell lymphoma initially felt to have lymphocytic thyroiditis in a patient with Hashimoto’s thyroiditis and SLE.

Objective: Chronic rhinosinusitis (CRS) is prevalent and causes a great negative impact on quality of life. Primary antibody deficiency (PAD) is highly prevalent with CRS compared to background population. There are efficient treatment options to consider when CRS is a symptom of PAD. The condition seems to be underdiagnosed. Design: A prospective cohort-study investigating adults with CRS following the EPOS 2020 criteria for possible PAD. Results: 138 patients were included in the study. Mean age was 49 years. Twenty-nine (21%) had hypogammaglobulinemia. Nine of 83 (11%) patients had insufficient response to pneumovax polysaccharide vaccine, but insufficient clinical history for diagnosis of Specific Antibody Deficiency (SPAD). Four patients met the clinical criteria for PAD; one had Common Variable Immune Deficiency (CVID), one had IgA deficiency and two had IgG subclass deficiency. No clinical characteristic was predictive of PAD and severity of CRS was not indicative of hypogammaglobulinemia or insufficient vaccine response. Conclusion: Immunoglobulin testing should be a routine part of the diagnostic work-up in chronic rhinosinusitis before considering biologics, as primary antibody deficiency is an under-recognized but treatable cause of refractory disease. Keywords

Purpose There are few comparative studies for Apixaban and Rivaroxaban in Asian Atrial Fibrillation (AF) patients. Our primary objectives were to investigate the relative safety and effectiveness of Apixaban versus Rivaroxaban for 1) all bleeding (major and clinically relevant non-major bleeding), and 2) composite of ischemic strokes and all-cause mortality outcomes. Methods In an active comparator, new-user cohort study with a follow-up period of 2-years, we followed 2,532 patients (Apixaban: n=1,273, Rivaroxaban: n=1,259) who were adults aged 21 years and above from Singapore with an inpatient index diagnosis of AF from 1 January 2019 to 31 December 2020. We used a database containing electronic health records from all public healthcare institutions in Singapore. We ascertained baseline covariates and time to their first events by comprehensive chart review of discharge summaries, emergency department notes and laboratory tests. Results In modified intention-to-treat analyses adjusted on confounders identified in directed acyclic graphs, initiating Rivaroxaban at the point of index AF was associated with a small increased risk of all bleeding as compared to Apixaban over 2-years (HR=1.26, 95% CI: 1.04-1.53), although we observed attenuated effects in on-treatment analyses (HR=1.17, 95% CI: 0.92-1.49). We observe no evidence for differences between initiating either agent for the composite of ischemic strokes and all-cause mortality (HR=0.85, 95% CI: 0.68-1.06). Conclusions In patients newly diagnosed with AF in Singapore, there is a small increased risk of major and clinically relevant non-major bleeding in patients initiated on Rivaroxaban as compared to Apixaban. This is consistent with many other observational studies, although we observe a much smaller magnitude of a bleed risk difference in our population. We are unable to dismiss that small differences may be present for ischemic stroke or all-cause mortality among Apixaban and Rivaroxaban users and recommend larger further studies to confirm these findings.

A Bear of a Case: Multidisciplinary Reconstruction Following a Grizzly Bear MaulingJacob Beiriger BS1, Katherine R Keefe, MD2 J. Rhet Tucker DMD FACP3, Richard B. Cannon MD1, David Adams DDS, FACS3, Hilary C. McCrary MD, MPH11Department of Otolaryngology – Head and Neck Surgery, University of Utah, Salt Lake City, UT2Department of Otolaryngology – Head and Neck Surgery, University of California, Davis Health3The University of Utah, School of DentistryWord Count: 1614Pages: 4, Figures: 4, Tables: 0,Supplemental Figures: 0Corresponding Author:Hilary C. McCrary, MD MPHDepartment of Otolaryngology – Head and Neck SurgeryUniversity of Utah50 N. Medical Dr.SOM 3C120Salt Lake City, UT 84132Email: hilary.mccrary@hsc.utah.eduRunning Title: Grizzly Mauling Facial ReconstructionKeywords: Ear, Nose, and Throat; Epidemiology; Otolaryngology; Public Environmental & Occupational Health; SurgeryConflict of Interest: None to disclose.Funding: No external funding was received.Patient Consent: Written consent for publication and images was obtained and is on file.Permissions: Written permission for reproduced material from other sources was obtained.

Large Symptomatic Splenic Pseudocyst: Case report of a rare entityAuthors: Tasnuva Habib Neha1,#, Mobin Ibne Mokbul2,3#, Farjana Yesmin2, Amrita Shrestha3,4Sylhet MAG Osmani Medical College, Sylhet, Bangladesh.Dhaka Medical College Hospital, Dhaka, BangladeshDhaka Medical College Research and Academic Club, Dhaka Medical College, Dhaka, BangladeshSilverline Hospital, Lekhnath Marg, Kathmandu, Nepal#Both authors are joint first authors.Corresponding Author: Mobin Ibne Mokbul, Dhaka Medical College Hospital, Dhaka, Bangladesh, Email:mobin.dmc@gmail.com , Contact: +8801763575425

Background Valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) is increasingly used to treat structural valve degeneration. Permanent pacemaker implantation (PPI) following TAVR is associated with increased morbidity and mortality, yet predictors specific to ViV-TAVR remain poorly defined. Objective To identify clinical and procedural predictors of PPI in patients undergoing ViV-TAVR. Methods We conducted a retrospective observational study of consecutive ViV-TAVR cases at the Mayo Clinic from 2012 to 2022. Clinical, ECG, procedural data and fluoroscopic measurements were analyzed, and propensity score matching was used to adjust for confounding. Predictors of PPI were identified using multivariable logistic regression. Results Among 261 patients, 24 (9.2%) required PPI. Balloon-expandable valves were used in 66.7% and self-expanding valves in 33.3%. Predictors of PPI included pre-procedural bifascicular block (OR 12.15, 95% CI: 2.52–68.89, p=0.003), greater septal implantation depth (OR 1.29, 95% CI: 1.04–1.65, p=0.019), and post-procedural new left (OR 23.56, 95% CI: 4.91–48.52, p=0.0004) and right bundle branch blocks (OR 24.4, 95% CI: 3.82–30.51, p=0.001). Aortic regurgitation as the mechanism of prosthetic valve failure was associated with reduced PPI odds (OR 0.28, 95% CI: 0.10–0.76, p=0.014). Pacing requirement—defined as >90% ventricular pacing—increased from 25% at 3 months to 56.25% at 12 months. At a median follow-up of 962.5 days (IQR 481.5–1555.3), adjusted mortality was significantly higher in the PPI group (aOR 9.4, 95% CI: 1.9–60.4, p=0.028). Conclusion Bifascicular block, greater septal depth, and new bundle branch blocks predict PPI post-ViV-TAVR, while aortic regurgitation appears protective. Risk stratification and procedural planning are critical.

At present, most pipeline robots can only work on a specific type of pipeline. However, the types of pipelines are always changing, which makes it difficult to meet diversified needs. Thus, a variable structure adaptive soft robot (VSASR) is proposed in this paper. The VSASR is driven by a coupled flexible actuator consisting of a flexible cantilever and a flexible pedrail. The VSASR can change the driver structure according to different pipeline environments to adapt to a variety of complex pipeline environments. The VSASR has strong flexibility and adaptability; it can climb on the inner and outer walls of pipelines by changing the driver structure and have excellent performance in many kinds of unstructured complex pipes that may contain obstacles, sudden turns, and sudden changes in the diameter. Furthermore, The VSASR provide a feasible scheme for pipeline robots when they face various and complex pipeline environments.

A document by Eckard Hamelmann. Click on the document to view its contents.

Objective: To evaluate the prognostic significance of preoperative inflammatory markers including platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR) and albumin-to-globulin ratio (AGR) in patients with laryngeal squamous cell carcinoma (LSCC) undergoing total laryngectomy (TL). Methods: Patients were stratified by preoperative inflammatory markers: NLR > 3, PLR > 109.54, and AGR < 1.29; values were obtained from blood tests within six months prior to surgery. The primary outcome was overall survival (OS). Secondary outcomes included postoperative complications, emergency department (ED) visits, and length of hospitalization. Multivariable analyses adjusted for age, sex, comorbidity burden, socioeconomic status, and prior radiation exposure. Results: A total of 616 patients included (mean age 67 years; 85% male). Low AGR was significantly associated with longer hospital stays, higher ED visit rates at 3, 6, and 12 months (p < 0.001), and reduced 1, 2, and 5-year survival (p = 0.01, 0.02, 0.003). NLR > 3 predicted longer hospitalization (p = 0.019) and more frequent ED visits (p < 0.01), PLR > 109.54 was associated with increased ED visits and lower 5-year survival. In multivariable models, only AGR < 1.29 remained a strong independent predictor of ED visits and mortality. Stratified analysis showed that this association persisted in patients without prior radiation (HR: 3.32; p = 0.002), but not in those who underwent salvage TL. Conclusion: Low preoperative albumin-to-globulin ratio (AGR) is an independent predictor of reduced OS in patients undergoing TL for LSCC. Incorporating AGR into preoperative risk assessment may help identify high-risk patients and inform clinical decision-making.

A document by Gonzalo Diaz Babio. Click on the document to view its contents.

Biodiversity is widely known to be a crucial measure of an ecosystem’s ability to adapt and recover from various disturbances. Farming practices, such as the cultivation of monocultures, are known to disrupt these ecosystems, altering the landscape and the associated biodiversity. It has thus become crucial to focus on restoration treatments to combat this biodiversity loss. Studying diversity levels in old fields allows us to identify the patterns and functions of these organisms, which can help regulate and conserve biodiversity, specifically in the agricultural sector. The main aim of this study was to assess the pace of natural recovery for a chronosequence of formerly planted fields in a grassland habitat in the Eastern Cape, South Africa. The plant communities were evaluated using species counts, while the bacterial communities were assessed through high-throughput sequencing (HTS) of the 16S rRNA gene. The alpha diversity indices indicated that the diversity levels within the old fields have started to resemble natural conditions for both the plant and microbial communities. Furthermore, the NMDS analyses identified clear variations in bacterial and plant community compositions among differently aged successional groups and the natural habitats. This study provides evidence that biodiversity levels within crop fields can recover from agricultural disturbances. However, considering the significant changes in climate and rainfall patterns in the study area, it remains unclear whether the community structures of the crop fields will reach native conditions in the coming decades, if at all.