Background:This prospective study aims to reveal whether the lesion is a benign pathological process or malignant by measuring ADC values under PI-RADSv2.1 guidance on MpMRI examinations. Additionally, the paper evaluates whether there is a correlation between malignant lesions’ pathological grade and ADC values, and whether ADC values provide noninvasive information about prostate cancer aggressiveness. Purpose:To determine the cut-off ADC values that may exist to identify and distinguish between benign and malignant lesions and also identify cancers with an ISUP score≥2 and cancers with an ISUP score1 defined as silent disease. Methods:This study includes 243 patients and they were diagnosed with TRUS-guided cognitive MRI fusion as tissue diagnosis. MpMRI images were evaluated before biopsy according to PI-RADSv2.1 guideline by a radiologist. Three groups which are benign prostatic tissue, prostatitis, prostate cancer, were obtained according to the histopathological results. Results: When the cut-off value for ADC is 780 x10-3, sensitivity was 80%. When the cut-off value was taken as 668 x10-3, the sensitivity was found to be 72% and specificity 62%. When the cut-off ADC value was taken as 647 x10-3, the sensitivity was 83% and the specificity was 48.5%. ADC values varied significantly according to ISUP groups [p= 0.003]. It was determined that ISUP 1 group was significantly higher than each of the other groups. ADC group mean values did not show a statistically significant difference between Group 2,3,4 and 5. Conclusion:ADC value shows significant potential, and may it improve the diagnostic accuracy.

Objective: Smoking is a significant health problem as the main cause of many diseases. In this study we aimed to investigate the early stage changes in the quality of life and the lung function following the cessation of smoking and to investigate the relationship between these changes in the patients who admitted to our smoking cessation outpatient clinic. Methods: A total of 112 smoking cessation patients who admitted to Turgut Ozal Medical Center Smoking Cessation outpatient clinic were investigated. The patients answered a questionnaire, a health quality test Quality of Life Assessment Scale (SF-36), Fagerström Nicotine Addiction Test (FNAT) and they were given Pulmonary Function Test (PFT) and the test and repeated at the end of the first and the third months. “SPSS (Statistical Package for Social Sciences) for Windows 22.0” was used for statistical analysis and a p< 0.05 was used to determine statistical significance. Results: The analysis was carried out on 112 individuals who applied to the smoking cessation polyclinic. FEV₁(L), FVC (L) and FEF25-75 (L) values were significantly lower in females compared to males and there was not any difference between the groups in FEV₁/ FVC (L) values (p> 0.05). We observed no improvement in terms of pulmonary function tests (PFT) after smoking cessation whereas a significant development was observed in terms of life quality (p< 0.05). Conclusion: We found that respiratory functions did not improve after smoking cessation whereas the quality of life improved significantly in the early period. While the effects of smoking cessation on the respiratory functions and quality of life on long term are emphasized in the literature, in this study we demonstrated that the quality of life improves regardless of respiratory functions in the early period of cessation.

Objectives: Vitamin B12 deficiency is a cause of preventable growth and developmental retardation in children. In this respect, alternative methods such as oral and sublingual treatments are being tried. We aimed to compare the efficacy of oral, sublingual and intramuscular vitamin B12 treatments in children aged 0-3 years. Methods: The study included 158 patients with serum vitamin B12 deficiency (serum vitamin B12 level <300 pg/ml) aged 0-3 years retrospectively. According to the vitamin B12 treatment modalities, the patients were divided into three groups as oral cyanocobalamin (group 1), sublingual methyl-cobalamin (group 2) and intramuscular cyanocobalamin (group 3). Results: The mean values of vitamin B12 levels increased to above 300 pg/ml in all of three groups . This increase was statistically significant for Group 1,2 and 3 (p<0.05). Conclusion: Sublingual methyl-cobalamin was determined as effective as oral and intramuscular cyanocobalamin improving vitamin B12 levels aged 0-3 years.

Objectives: Cell membrane fluorescent dye known as DiO/DiD has been suggested for its stability and safety as an effective tool for live cell staining. This study developed a novel cell proliferation detection technology based on DiO/DiD. Materials and Methods: Labelling of tumor cells using membrane fluorescent dye DiO/DiD, and the fluorescence intensity was measured by usig fluorescence-activated cell sorting. The number of different tumor cell divisions was calculated through the standard curves by measuring the fluorescence intensity. Labeled cells was treated with different concentrations of doxorubicin to investigate the effect of chemotherapy on labeled cells. DiO-labeled tumor cell were injected into different organs and tissues to explore the relationship between the number of cell divisions and tumor growth. Results: Tumor cells can be divided into DiO-High and DiO-Low subgroups after chemotherapy and a higher proportion of CD133 was observed in the DiO-High cell subgroups compared to DiO-Low cell subgroups. Besides, the tumor cells from metastatic tumors proliferated more rapidly than those in situ. Conclusions: Application of cell membrane dye DiO/DiD in the quantitative detection of cell proliferation method is expected to be more feasible and applicable in future studies.

Previous phenological analyses of GBIF records ignored data biases and produced misleading results. Here we demonstrate how data sufficiency and methodology affect inferred latitudinal patterns in lepidopteran phenology, highlighting the importance of spatiotemporal data aggregation decisions. Results indicate later and/or shorter flight period phenology at higher latitudes is common.

Climate warming is causing asynchronies between animal phenology and environments. Mismatched traits, like coat colour change mismatched with snow, typically decrease survival. However, coat change does not serve a singular adaptive benefit of camouflage, and alternate coat change functions may confer advantages that supersede mismatch costs. We found that mismatch reduced autumn mortality risk of snowshoe hares in the Yukon by 86.5 %. We suggest that the increased coat insulation and lower metabolic rates of winter acclimatized hares confer energetic advantages to white mismatched hares that reduce their risk of dying. We found that white mismatched hares forage 17-77 minutes less per day than matched brown hares between 0 and -10 ºC, thus lowering their predation risk and increasing survival. We found no effect of mismatch on spring mortality risk, where mismatch occurred at warmer temperatures, suggesting a potential temperature limit where the costs of conspicuousness outweigh energetic benefits.

Objective: To analyze the correlation between iron status and thyroid hormone in pregnant women during their second trimester of pregnancy. Design: A hospital-based case-control study. Population: A total of 550 pregnant women were recruited from Pingguo Maternity and Child Health Hospital. Method: Data was grouped by SF concentration, and was performed by correlation and regression analysis. Main outcome measure: Iron nutritional status and thyroid hormones. Results: A significant difference was found in thyroid hormone level, including FT3, FT4, and TSH (all P < 0.01) between two groups (Mann-Whitney U test), and the levels of FT3 and FT4 were significantly lower in the iron deficiency group. Spearman’s correlation analysis showed that both of SF and Hb were correlated with FT3, FT4, and TSH (all P < 0.01). Canonical correlation was used to analyze the interrelationships between iron status and thyroid hormones, showing SF was positively associated with the FT3 level. The elastic network regression indicated that the coefficient of Hb was greater than that of SF. Conclusion: Our study indicated that iron nutritional status is associated with thyroid hormone levels during the second trimester of pregnancy, suggesting that ID may be an important risk factor in thyroid hormone levels. Involving two common endocrine diseases in pregnancy, the relationship between ID and thyroid hormone deserves further investigation. Tweetable abstract: Iron nutritional status is associated with thyroid hormone levels during the second trimester of pregnancy. Key-words: Iron status, thyroid hormones, the second trimester of pregnancy, canonical correlation, elastic network regression

Objective：To study the risk factors of cervical insufficiency (CI). Design：Retrospective controlled study. Setting：First Hospital of Shanxi Medical University. Population：209 CI patients with a singleton pregnancy (CI group) and 348 patients randomly selected (control group). Methods and main outcome measures：All patients were required to have records of the whole pregnancy. The general conditions and pregnancy complications of the two groups were collected. A model of logistic regression and ROC curves were used. Results：Patients with a history of multiple pregnancies had a 17.51 times higher risk of CI than negative patients(OR=17.51, 95%CI: 2.16-141.85, P=0.007); patients who were pregnant by IVF-ET/ovulation induction had a 3.26 times higher risk of CI than negative patients(OR=3.26, 95%CI: 1.69-6.30, P<0.001); patients with gestational diabetes (GDM) or pregnancy with diabetes (PGDM) had a 2.88 times higher risk of CI than negative patients(OR=2.88, 95%CI：1.87-4.44, P<0.001); patients with PCOS had an 8.72 times higher risk of CI than negative patients (OR=8.72, 95%CI: 2.33- 32.64, P=0.001); and patients with uterine malformations had a 4.00 times higher risk of CI than negative patients(OR=4.00, 95%CI：1.07-14.97, P=0.040) . The ROC curve showed the combination of multiple indicators have a certain predictive ability for CI (AUC=0.728). Conclusions：Previous multiple pregnancy, IVF-ET/ovulation induction conception, diabetes mellitus (GDM or PGDM), uterine malformations, and PCOS are risk factors for the incidence of CI, and the combination of multiple indicators has some predictive ability for CI. Funding：None

Objective: To determine the menstrual characteristic and its related morbidities among adolescent girls living in Sabah of North Borneo, Malaysia. Design: Cross-sectional study. Setting: Three government high schools located in Ranau, Sabah. Population or Sample: A total of 757 girls aged between 14 and 19 years. The participants were female adolescent volunteers who have attained menarche. Methods: Data were based on a quantitative survey. Main Outcome Measures: Based on the analysis of questionnaires completed by 757 adolescent girls, the mean age was 17 ± 1.4, and the mean menarche age was 12.2 ± 1.1. Our data demonstrated that 85.7% of the participants experienced dysmenorrhea, of which at least 42% (mean pain score±SD: 4.81±0.76, 95% CI: 4.7, 4.9) experienced moderate dysmenorrhoea and 11.3% (mean pain score ± SD: 7.86±0.97, 95% CI: 7.6, 8.1) documented severe dysmenorrhea. More than 70% of these girls complained of tiredness, headache, and appetite change during their menses. Conclusion: The prevalence of menstrual disorders and its related morbidities among girls residing in Sabah is high. Reproductive health issues remain poorly addressed in rural and socio-economic deprived areas. The main consequence of neglecting menstrual disorder and its related morbidities is impaired future sexual reproductive health as an adult. Hence, addressing adolescent reproductive health issues is crucial, especially among girls living in areas where healthcare accessibility is difficult. Information gathered from this study is required to strategise an effective intervention to improve adolescents’ reproductive health status in rural areas.

Morphology-performance (M-P) mapping seems to be predictive of how morphology may evolve along “functional lines of least resistance”, regardless of genetic effect, but as yet it is not clear the strict (or mathematical) definition of the least functional resistance and how M-P mapping determines it. We recorded station-holding and swimming performance using a published critical swimming speed (Ucrit) test in Chinese sturgeon Acipenser sinensis, and used Ucrit as a proxy for fitness. We addressed a geometric morphometric framework to initiate Arnold’s “morphology-performance-fitness” path model (Arnold, 1983), assessing and visualizing apparent and direct M-P mapping. We quantified them as that one unit of the most-performance-covaried shape vector generated fapparent and f units of standardized performance, respectively. We defined the least functional resistance as the theoretically minimum morphological variation on an arbitrary direction in morphospace required by one unit of standardized fitness, (|b-1|min), which was calculated as a multivariate function of direct M-P mapping (f), together with the angle between paired most-performance-covaried shape vectors in morphospace (θ) and direct performance effect on fitness (w), given dual performance systems. The simulated and empirical data suggested that |b-1|min was constrained by larger sum of absolute direct effects (|fhold| + |fswim|) and absolute functional interaction (|fhold fswim cos θ|), and its direction was biased by magnitude of direct M-P mapping.

Modern treatment in childhood acute lymphoblastic leukemia (ALL) resulted in high cure rate. However, it causes central nervous system toxicity. A group of 136 ALL survivors were screened for P300 potentials changes. Therapy was conducted according to modified New York (NY - 30 patients) and two subsequent revisions of modified Berlin-Frankfurt-Münster (BFM - 32 and 74 patients). The control group consisted of 58 patients. The survivors had significantly prolonged the mean latency of P300 (331.31+/-28.71 vs 298.14+/-38.76 ms, P<0.001) and reaction time (439.51+/-119.86 vs 380.11+/-79.94 ms, P=0.002) compared to the control group. Abnormalities in the endogenous evoked potentials were observed in 36 patients (26,5%). The mean latency time was significantly longer compared to the control group (NY: 329.13+/-28.07 ms, P=0.001; pBFM: 332.97+/-23.97 ms, P<0.001; BFM95: 331.47+/-31.05 ms, P<0.001). The reaction time was similarly prolonged in both groups. The most significant prolongation was recorded in the NY group (461.8+/-140.3 vs 380.1+/-78.04 ms, P=0.039). Significantly higher frequency of prolonged reaction time in non-irradiated BFM95 patients was found (21.62 vs 15.85%, P=0.007). Radiotherapy have significantly reduced the P300 wave amplitude (mean values: 10.395+/-5.727 vs 12.739+/-6.508 ms, P=0.027). Endogenous P300 event-related potentials may be useful in screening of subclinical cognitive changes in ALL survivors.

Objective: Cytokine storm and Coagulopathy have been implicated as major causes of morbidity and mortality in COVID-19 patients. A black yeast Aureobasidium pullulans AFO-202 strain produced beta 1,3-1,6 glucan has been reported to offer potential immune enhancement and metabolism balancing, as well as mitigation of coagulopathy risks. The N-163 strain produced beta glucan is an efficient anti-inflammatory immune modulator. In this pilot clinical study, we report the beneficial effects of these two beta glucans on the biomarkers for cytokine storm and coagulopathy in COVID-19 patients. Methods: A total of 24 RT-PCR positive COVID-19 patients were recruited (Age range: 18~62; 17 males and 7 females). Patients were randomly divided into three groups (Gr): Gr. 1 control (n=8); Gr. 2: AFO-202 beta glucan (n=8); and Gr. 3, a combination of AFO-202 and N-163 beta glucans (n=8). All three groups received the standard care while groups 2 and 3 received additional supplementation of beta glucans for 30 days. In addition to basic clinical parameters, we periodically evaluated D-Dimer, IL-6, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), the neutrophil to lymphocyte ratio (NLR), the lymphocyte to CRP ratio (LCR) and the leukocyte-CRP ratio (LeCR). Results: The duration of hospital stay for all three groups was nearly equivalent. There was no mortality of the subjects in any of the groups. Intermittent oxygen was administered from day of admission for up to four to five days with mask (two to four Lpm) to two subjects in Gr. 2 and one subject in Gr. 3. None of the subjects required ventilation. The D-Dimer values in Gr. 1, which was on average 751 ng/ml at baseline, decreased to 143.89 ng/ml on day 15, but increased to 202.5 ng/ml on day 30, which in groups 2 and 3 decreased on day 15 and continued to remain at normal levels until day 30. IL-6 levels decreased on day 15 from an average of 7.395 pg/ml to 3.16 pg/ml in the control, 26.18 pg/ml to 6.94 pg/ml in Gr. 2 and 6.25 pg/ml to 5.22 pg/ml in Gr. 3. However, when measured on day 30, in Gr. 1, the IL-6 increased to 55.37 pg/ml while there was only slight marginal increase in Gr. 2 but within normal range, and the levels further decreased to less than 0.5 pg/ml in Gr. 3. The same trend was observed with ESR. LCR and LeCR increased significantly in Gr. 3. NLR decreased significantly in groups 2 and 3. There was no difference in CRP within the groups. Conclusion: In this exploratory study, consumption of Aureobasidium pullulans produced beta glucans for thirty days, results in a significant control of IL6, D-Dimer and NLR, a significant increase in LCR, LeCR and marginal control of ESR in COVID-19 patients. As these beta glucans are well known food supplements with decades of a track record for safety, based on these results, we recommend larger multi-centric clinical studies to validate their use as an adjunct in the management of COVID-19 and the ensuing long COVID-19 syndrome.

The prognosis of patients with ovarian cancer (OC) is highly heterogeneous which hinders to make an appropriate clinical decision. The study aimed to stratify patients’ prognoses by establishing a risk assessment model in the context of mRNA levels of immune-related genes (IRGs). Comprehensive bioinformatics analyses were done using datasets from The UCSC Xena platform, ICGC Data Portal, The Cancer Genome Atlas (TCGA), and the Genotype‐Tissue Expression (GTEx) project. LASSO regression was done to determine the independence of associations of specific factors with overall survival (OS). Nomogram that combined the independent prognostic factors was constructed to predict the OS of OC patients. The tumor microenvironment and immune response were estimated by cell type identification via estimating the relative subset of known RNA transcripts (CIBERSORT) and immunophenoscore (IPS). Overall ten IRGs were significantly associated with the OS probability and were used for the prognostic model construction of OC patients. According to the prognostic model, ovarian cancer samples were identified as high- or low-risk group. A nomogram containing risk score, stage, histological grade and age could significantly predict 1-year, 3-years, and 5-years OS probability of OC patients, as well as a higher IPS score and a higher immunoreactivity phenotype, which were probably correlated with better immunotherapy response and good prognosis. In conclusion, we established a reliable IRGs-based risk model with potential prognostic value for patients with ovarian cancer. Further studies are needed to confirm these prognosis-associated biomarkers.

Objective In this study, it was aimed to compare ocular surface changes and dry eye parameters between migraine patients and healthy individuals. Material and Methods The participants of the present cross-sectional comparative study are 30 migraine patients and 31 age and gender matched healthy individuals. The demographic and clinical data of migraine patients were recorded. Ocular surface changes were evaluated using Schirmer I test, tear break-up time (TBUT), Ocular Surface Disease Index (OSDI) scores and conjunctival impression cytology (CIC) grades were assessed and results were compared between the two groups. Results CIC degrees of the migraine patients were higher than the control group (p<0.001). CIC assessment of the migraine group revealed that ten patients (33.3%) were of grade II-III, whereas the CIC assessment of two (6.5%) participants in the control group was grade II. Grade III CIC was not determined in the control group. TBUT in the migraine group was lower compared to the control group (p=0.023) and Schirmer I was (p=0.013) lower and OSDI score higher (p<0.001). In the migraine group, there was an inverse correlation between CIC grade, Schirmer I test (p=0.001, ρ=-0.559) and TBUT (p<0.001, ρ=-0.778). Conclusion Objective signs and subjective symptoms of dry eye are common in patients with migraine. Abnormal CIC evaluation findings such as morphological changes in the bulbar conjunctiva, goblet cell loss, and squamous metaplasia suggest the presence of inflammation. These findings too, support the hypothesis that dry eye and changes in the ocular surface may play a role in the pathogenesis of migraine.

Drought-associated water shortage a complicated hazard, and extreme weather and climate events have serious impacts on agricultural, ecological, and socio-economic activities in any society. Several drought indices have been developed over the past decades for assessing the scope, start, duration, and intensity of drought. This work focuses on drought analysis using a high-resolution remote sensing and meteorological dataset from MODIS’ NDVI and LST to evaluate the Spatio-temporal distribution drought events and intensities in three physiographic regions of the USA from 2000 – 2019. Results were compared with other remote-sensing-based drought indices, such as the temperature condition index (TCI), Vegetation Health index (VHI), and it was observed that the VCI and VHI, which was a combination of vegetation and meteorological information, had a strong correlation with precipitation data than the NDVI-derived VCI. The results demonstrated the severity of vegetation stress and extreme droughts in 2000, 2006, 2011, and 2012. The long-term agricultural drought situation and compared with other drought indices, reveals a good agreement as to the TCI, VHI, and precipitation anomalies also decreased significantly.

Background: Optimum treatment options for arterial thrombosis are antiplatelet and anticoagulant treatments. We evaluated the effectiveness of Apixaban and Rivaroxaban treatment for preventing intimal hyperplasia in rabbits. Methods: The rabbits (n = 15) were randomly divided into three groups. Reanastomoses applied on the carotid artery site. All groups received 100 U/kg heparin sodium during operation period. Group A (n = 5) as a control group had no medication. Group B (n = 5) was given Rivaroxaban 3 mg/kg/day. In-group C (n = 5) Apixaban was administered perorally 10 mg/kg. At the end of the treatment on the 28th day, carotid artery specimens excised and evaluated histologically. Results: Increased intima thickness was observed in the control group than the drug groups (p<0.009). It was found that there was no difference between groups in terms of lumen diameter, lumen area, tunica media area and tunica media thickness (p>0.005). There was expressive difference between groups in terms of α-SMA distribution or Tunel staining (p<0.05, p<0.019). The p value was less than 0.05. Conclusion: Apixaban and Rivaroxaban had better efficacy on the results against intimal damage after carotid artery surgery.

Objectives: We aimed in this study to evaluate and present the long-term results of type 1 tympanoplasty patients who were operated on by using boomerang-shaped chondroperichondrial graft. Methods: The study was designed retrospectively. One hundred and thirty-eight patients who underwent primary type 1 tympanoplasty with tragal, boomerang-shaped chondroperichondrial graft between September 2010 and March 2014 were included. Patients invented to control examination between January 2021 and April 2021, and 62 patients complete control visits after invitation. Audiological results and otomicroscopic findings were recorded. The graft status, preoperative and postoperative air-bone gap (ABG) values and presence of retraction were identified and compared with preoperative findings. Results: The preoperative mean ABG value of the patients was 23.69 ± 1.03 dB. Control ABG was calculated as 10.6 ± 0.7 dB (p<0.0001). The audiological test performed after a mean of 68.5 + 14.2 (min: 60, max: 96) months after the surgery. The average follow-up period was found as 73.03 ± 12.4 (min: 60, max: 122) months. Perforation was detected in 6 (9.7 %) patients. Conclusion: Considering the long-term results, we think that this grafting technique of tympanoplasty has adequate and satisfactory results.

OBJECTIVE: Media-based educational interventions applied by healthcare providers may improve women‘s adherence, health literacy and awareness of LRRFs, and off-spring health outcomes. This study aims to investigate whether exposure to media-based educational interventions in gynecological and obstetric care are associated with self-assessed levels of knowledge on LRRFs during pregnancy and lactation. DESIGN: We conducted a cross-sectional observational study. SETTING: The study was carried out across 14 randomly generated sample points in the twelve most-populated cities in Ba-den-Wuerttemberg, South-West Germany. Women were recruited in gynecological and obstetric institutions. SAMPLE: The study sample comprised of 219 women who met our inclusion criteria and completed the quantitative questionnaire. METHODS: We applied ordinal logistic regression analyses to calculate Odds Ratios (ORs) and 95% Confidence Intervals (CIs). MAIN OUTCOME MEASURES: Women’s self-assessed level of knowledge in relation to the exposure to media-based educational interventions by healthcare providers. RESULTS: Media-based educational interventions on LRRFs during pregnancy through gynecologists and/or midwifes are significantly associated with women’s self-assessed level of knowledge (gynecologists: OR 4.26 (95% CI 2.04, 8.90; p <.001); midwifes: OR 3.86 (95% CI 1.66, 8.98; p=.002)). Similar results were found for media-based educational interventions through gynecologists and/or midwifes on LRRFs during lactation and its association with women’s self-assessed level of knowledge (gynecologists: OR 4.76 (95% CI 2.15, 10.59; p <.001); midwifes: OR 7.61 (95% CI 3.13, 18.53; p<.001)). CONCLUSION: The study suggests that exposure to media-based educational interventions in gynecological and obstetric care increases women’s level of knowledge on LRRFs during pregnancy and lactation.

The Intergovernmental Panel on Climate Change Report and the Obstetrician: A Perspective and a Call to Action1Jordan Emont, MD MPH ScM1Department of Obstetrics and GynecologyColumbia University Irving Medical Center622 West 168th Street, PH 16New York, NY 10032 USAje2603@cumc.columbia.edu212-305-2376Running Title: The IPCC Report and the ObstetricianWord Count: 491The newest report from the Intergovernmental Panel on Climate Change (IPCC) released this month confirmed everything we know about climate change: it is happening, all experts agree, and while things will get worse there is still a chance for us to make things better (IPCC 2021).Healthcare professionals are aware of the health risks of climate change but often face barriers to advocating for and educating patients about these risks (Kotcher et al. 2021). In the field of obstetrics, these barriers can be manifold including limited time and lack of provider education about the climate risks to pregnancy. As the world continues to warm, weather will become increasingly unpredictable and extreme. Healthcare professionals will again be on the front line of another pandemic, that of climate-induced disease. Pregnant patients will look to their obstetricians for guidance on preventing deleterious outcomes. There are simple actions we can take to step into this role.First, we must educate ourselves about these risks in order to help guide our patients appropriately. Anyone who has worked in an obstetric triage on a hot day knows that heat can be very uncomfortable and can cause preterm contractions for pregnant patients. Excess heat exposure has been demonstrated to be associated with preterm birth and low birth weight, two of the leading causes of infant morbidity and mortality (Bekkar et al. 2020). Exposure to particulate matter, for example from air pollution and wildfires, has a similar association (Bekkar et al. 2020). New precipitation and heat patterns will change distributions of mosquito vectors that can carry teratogenic infections such as Malaria and Zika (Rocklöv and Dubrow 2020). Finally, climate disasters such as floods and hurricanes limit access to adequate pregnancy care thus leading to poor maternal/fetal outcomes.Second, we must educate patients about how to avoid such risks. While time is often a barrier for obstetricians to provide thorough education, reminding patients about the value of adequate hydration and cooling on a hot day take seconds of a prenatal visit. Furthermore, clinics can create educational materials and utilize support staff for patient education. For example, a project in El Paso, TX on maternal heat safety utilized pamphlets and community health workers to empower patients to monitor their own climate health (Monteblanco et. al 2021).Third, healthcare professionals have a responsibility to not only be on the front lines of clinical care for the climate affected mother but also to advocate on local, national, and international platforms. The siren of climate change has rung since at least the 1970s with minimal initiative worldwide. It is now the health of people, specifically mothers and children, that will need to lead the argument for climate action. The new IPCC report identifies that immediate international curbs to greenhouse gas emissions can limit the very worst predictions for the future of the world.The IPCC report is a reminder of the challenges we face for pregnant women worldwide in the era of climate change. With education and advocacy, obstetricians can help prevent poor outcomes associated with climate change for our patients now and in the future.Acknowledgements: NoneDisclosure of Interest: NoneContributions to Authorship: The manuscript was conceived, written, and edited by J EmontEthics Approval: Not requiredReferences:IPCC, 2021: Climate Change 2021: The Physical Science Basis. Contribution of Working Group I to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change [Masson-Delmotte, V., P. Zhai, A. Pirani, S. L. Connors, C. Péan, S. Berger, N. Caud, Y. Chen, L. Goldfarb, M. I. Gomis, M. Huang, K. Leitzell, E. Lonnoy, J. B. R. Matthews, T. K. Maycock, T. Waterfield, O. Yelekçi, R. Yu and B. Zhou (eds.)]. Cambridge University Press. In Press.Kotcher, John, Edward Maibach, Jeni Miller, Eryn Campbell, Lujain Alqodmani, Marina Maiero, and Arthur Wyns. “Views of Health Professionals on Climate Change and Health: A Multinational Survey Study.” The Lancet Planetary Health  5, no. 5 (2021). https://doi.org/10.1016/s2542-5196(21)00053-x.Bekkar, Bruce, Susan Pacheco, Rupa Basu, and Nathaniel DeNicola. “Association of Air Pollution and Heat Exposure WITH Preterm Birth, Low Birth Weight, and Stillbirth in the US.” JAMA Network Open  3, no. 6 (2020). https://doi.org/10.1001/jamanetworkopen.2020.8243.Rocklöv, Joacim, and Robert Dubrow. “Climate Change: An Enduring Challenge for Vector-Borne Disease Prevention and Control.” Nature Immunology  21, no. 5 (2020): 479–83. https://doi.org/10.1038/s41590-020-0648-y.Monteblanco, Adelle Dora, Jennifer K Vanos, Sarah LeRoy, Patricia M Juarez, and Gregg M Garfin. “An Evaluation of a Maternal Health and Extreme Heat Exposure Training.” Journal of Social, Behavioral, and Health Sciences  15, no. 1 (2021). https://doi.org/10.5590/jsbhs.2021.15.1.02.

There is about to be an abrupt step-change in the use of our coastal seas, specifically by the addition of large-scale offshore renewable energy developments to combat climate change. Many trade-offs will need to be weighed up for the future sustainable management of marine ecosystems between renewables and other uses (e.g., fisheries, marine protected areas). Therefore, we need a much greater understanding of how different marine habitats and ecosystems are likely to change with both natural and anthropogenic transformations. This work will present a synthesis of predictive non-mechanistic Bayesian approaches from ecosystem level, through to fine scale mechanistic understanding of foraging success by individual species, to identify accurate and consistent physical (e.g., bottom temperature) and biological (e.g., chlorophyll-a) indicators of habitat and ecosystem change over the last 30 years within a well-studied shallow sea. These combined approaches illuminate the feasibility of integrating knowledge across scales to be able to address the spatio-temporal variability of biophysical indicators to ultimately strengthen predictions of population changes at ecosystem scales across broadly different habitat types. Such knowledge will provide an effective baseline for more strategic and integrated approaches to both monitoring studies and assessing anthropogenic impacts to be used within marine spatial planning considerations.

Rationale, aims and objectives: We aimed to investigate whether a quality improvement initiative, implementing evidence-based return-to-work (RTW) services in a Danish job center, could reduce the duration of sick leave and increase self-reported outcomes in citizens on sick leave due to back pain. Method: The study was a quality improvement (QI) study, conducted in a large municipality, using a quasi-experimental prospective design. Citizens receiving sickness benefits due to back pain were allocated either to a department providing RTW services as usual or to the QI department. The QI intervention included earlier timing of contact with citizens, integrated collaboration between case managers and physiotherapists, and workplace involvement in the RTW process. The QI intervention was evaluated by measuring citizens’ rate of RTW, and their self-reported disability, self-efficacy for RTW and fear-avoidance beliefs. Follow-up varied from 3 to 15 months. Results: 324 citizens were included, of which 134 were allocated to the QI group. Sociodemographic characteristics of the QI and control groups were similar at baseline. No difference was seen on rate of RTW, with a hazard ratio of 0.95 (P = 0.741). For self-reported outcomes, the QI group reported significantly higher self-efficacy for RTW (P = 0.030), while there were no differences between groups on disability and fear-avoidance beliefs. Conclusions: The implementation of evidence-based practice in RTW-services for citizens on sick leave due to back pain in a Danish setting, did not have an effect on the rate of RTW, probably because the workplace involvement and close collaboration between physiotherapists and case managers at the job center had limited implementation success. However, self-efficacy for RTW was significantly higher in the QI group compared to the control group. The findings were confirmed in a per protocol analysis.

Objective: During the management of Human Immunodeficiency Virus infection, comorbidities such as opportunistic infections and other non-communicable diseases may occur which require co-medications and monitoring. The objective of this study was to assess the prescription pattern of antiretroviral drugs, comorbidities, and their management in HIV positive patients. Methods: This retrospective observational study evaluated the medical records of 150 in-patients diagnosed with HIV infection. The antiretroviral drugs prescribed for these patients were studied and the reported comorbidities and co-medications were evaluated. Results: The mean age of study population was 45.75 ± 10.15 years and a majority of the patients (40.7%) belonged to the 40-49 years’ age group. Anti-Retroviral Therapy (ART) was prescribed in 72% of the patients of which 88.0% were prescribed first-line ART. The most common ART regimen was istenofovir + lamivudine + efavirenz (50.93%), and lamivudine (88.0%) was the most commonly prescribed antiretroviral drug. On an average, each patient had 2.07 ± 1.072 comorbidities and tuberculosis was the most frequently encountered comorbidity (30.0%). Antiulcerants and antiflatulents (87.3%) were the most extensively used co-medications. A mean of 8 co-medications were prescribed per patient. Conclusions: This study is another evidence where comorbidities are common occurrence in HIV patients of all age groups and receive significant amount of co-medications. Hence, excellent care should be taken during prescribing and management of HIV- infected patients.

Keeping healthy status is the primary condition in endangered captive breeding of alpine musk deer (Moschus chrysogaster, AMD), and that captive breeding program is beneficial to the ex-situ conservation and wild population recovery of musk deer. Therefore, regulating the health status of captive musk deer is the premise of musk deer resource utilization. Meanwhile, gut microbiota is essential for host health, survival and environmental adaptation. However, the changes of feeding environment and food affected the composition and function of gut microbiota in musk deer. Here, 16S rRNA was used to reveal the composition and function variations between wild and captive AMD. Wild AMD had higher alpha diversity of gut microbiota, with higher relative abundance of phylum Firmicutes, and dominant genera UCG-005, Christensenellaceae R7 group, Monoglobus, Ruminococcus, and Roseburia, which conducive to the wild AMD more effective absorption and utilization of nutrients, stability of intestinal microecology, and adaption to complex natural environment. Captive individuals had higher metabolic functions, with higher relative abundance of phylum Bacteroidetes, and dominant genera Bacteroides, Rikenellaceae RC9 gut group, NK4A214 group and Alistipes, which contributed to the metabolic activities of various nutrients. Furthermore, 11 potential opportunistic pathogens in captive AMD were higher than those in wild AMD, with higher enrichment of disease-related functions. Compared with wild populations, captive musk deer had a higher risk of intestinal diseases. The results can provide a theoretical basis for healthy breeding of musk deer, and a guidance for evaluating the health status of wild release and reintroduction of musk deer.

Breed selection for commercial goat is needed for production efficiency, growth trait alteration, and improved livestock quality. Boer goat is famous for its stable production performance, fast growth rate, and high meat production. Detecting selective signatures in its genome can elucidate selection mechanisms for its economic and adaptive traits. In this study, 1,122,858 InDels were identified based on the whole genomes of 46 Australian Boer goats and 81 worldwide local goats. FST was used to identify the candidate selection signatures in 127 goats. A total of 11229 InDels were obtained from the top1% of all inDels, and 1239 candidate genes were annotated. A total of 1193 and 476 candidate genes were involved in 4726 GO terms and 299 KEGG pathways, respectively. Many genes were related to muscle development (MEF2C, MAPK14, TMOD1 etc.), reproduction (SRD5A1, FBXW11, DMRT1 etc.), immunity (CD200, SGK1, IL17RB etc.) and metabolism (INSR, STXBP3, H6PD etc.). The results provide novel and important insights into the genetic basis of selection in Boer goat and may be useful for goat molecular breeding.