Objective: The present study aims to investigate whether the COVID-19 pandemic has had a positive effect on Turkish society in terms of post-traumatic growth. Material and Methods: This quantitative, cross-sectional study employed the survey model. Prior to the research, all permissions were obtained, and the participants were informed. Results: More than half of the participants stated that they felt worried due to the pandemic. Similarly, more than half reported that they had treated COVID-19 at home. Those who reported that they were unemployed, those who thought their mental health was affected, and those who reported that they felt worried due to the pandemic scored high on the post-traumatic growth inventory. Conclusions: Some sociodemographic characteristics led to differences in the participants’ scores from the post-traumatic growth inventory.

Objective: Rheumatic heart disease (RHD) persists in low-middle-income countries and in high-income countries where there are health inequities. RHD in pregnancy (RHD-P) is associated with poorer maternal and perinatal outcomes. Our study examines health care perspectives of models of care for women with RHD-P. Design: Descriptive qualitative study exploring health professionals’ perspectives of care pathways for women with RHD-P. Setting: Australia Population: Nineteen participants from maternal health and other clinical and non-clinical domains related to RHD-P. Methods: Thematic analysis of semi-structured interviews. Results: A constellation of factors challenged the provision of cohesive women-centred care, related to health systems, workforces and culture. Themes included conduits of care - helping to break down silos of information, processes and access; ‘layers on layers’ – reflecting the complexity of care issues; and shared understandings – factors that contributed to improved understandings of disease and informed decision-making. Conclusions: Pregnancy for women with RHD provides an opportunity to strengthen health system responses, improve care pathways and address whole-of-life health. To respond effectively, structural and cultural changes are required including enhanced investment in education and capacity building – particularly in maternal health – to support a better informed and skilled workforce. Aboriginal Mothers and Babies programs provide useful exemplars to guide respectful effective models of care for women with RHD, with relevance for non-Indigenous women in high-risk RHD communities. For key goals to be met in the context of RHD, maternal health must be better integrated into RHD strategies and RHD better addressed in maternal health.

Objective: Study the effect of COVID-19 on pregnancy and neonatal outcomes. Design & Setting: Prospective cohort study in Combined Military Hospital (CMH) Bogura, Obstetrics and Gynaecology department. Methods: Collected and analysed data of 29 pregnant ladies positive for COVID-19 between June to October 2020 inclusive to assess the effect of COVID-19 on pregnancy, and neonatal outcomes. Control group was COVID negative pregnant patients. Nasopharyngeal swab was taken for real time polymerase chain reaction for detection of COVID-19. Main outcome measures: Compared age, symptoms, any complication in mother and fetus, mode of termination, and duration of hospital stay. Results: Mean age was 27.45 years in case and 28.10 years in control group (P value <0.503). Only six were asymptomatic (10.3%). Fifteen (25.9%) had fever, six had weakness (10.3%), five (8.6%) had sore throat, three (5.2%) had nausea and five (8.6%) presented with loss of smell. Among twenty-nine patients, five (8.6%) delivered normally, twenty four (41.4%) were delivered through caesarean section which was significantly higher than control group (P value <0.001) No mother became critical or expired, neonatal death was also absent. Mean duration of hospital stay was 14.13± 6.192 days in case and 5.18±4.99 in control which was significantly (P value <0.001) higher. Breast feeding was significantly higher in control group (P value <0.001). Conclusion: Present study shows feto-maternal outcome of COVID pregnancy does not vary to a great extent in comparison with normal pregnancy. Funding: No funding was required. Keywords: COVID-19, Maternal morbidity, Pneumonia, Pregnancy, COVID-19 in pregnancy

Preparation for the next pandemic-a plea for a nationalized approachAdam CohenLeiden University Medical CentreDepartment of Nephrologyac@ddcd.nlThis article is a translation and adaptation of an essay written in the Netherlands newspaper Trouw on March 28th 2020When the original version of this article was written on March 28th 2020, the outbreak of infections by the SARS-Cov19 virus had just been declared a pandemic and the Netherlands had gone in lockdown. Now, more than a year later, some fortunate countries are looking at a recovery, but there is more fear, uncertainty and suffering to be expected for many.The fact that we will emerge is to a certain extent a triumph for governments, health care systems and industries and the amount of collaboration has been unheard of. However, we need to question if what happened until now is the ideal situation. This is not an article to criticize what happened. No one was really prepared, and that errors and unwise choices were made was to be expected. Therefore, criticism with hindsight is less productive than planning for an even better response in the future.The question is if we will remember the severity of the crisis when everything is back to normal. We may not, and our current privatized system of vaccine and drug development is not structurally able to cope with what we have experienced. This may seem so, but we have experienced a mild general rehearsal for something much worse. That will happen when a virus mutates in a form that is more deadly and more infectious than the current one. Sars-Cov and Mers-Cov were failed attempts from the viral point of view, but with some other characteristics the disaster would have been infinity larger.We have seen excellent collaboration between all the different governmental bodies both international and national in limiting the damage and eventually winning the war against the virus. As the crisis went on the warlike rhetoric increased and it now looks as if we will win this war, or rather our immune system will win the war. The cost in casualties has been enormous and it is the question if that was inevitable.What should be remembered?Most if not all countries have an army. That is an expensive high technology system that luckily is rarely used to its full potential. The military must be ready, so they train on different scenarios, renew their procedures and equipment. Governments must buy expensive hardware like submarines, aircraft carriers or F35 planes (for about $100M per unit). There is NATO in which the different national armies collaborate and standardize so that they can fight together. Most countries spend considerable amounts of their national budgets on defense, without knowing against what. People understand that and there is no country in the world that even thinks about privatizing defense. In fact, any private involvement in defense is forbidden by law.Now think about the defense against the much more well defined and sneakier adversaries that cause infections. We share the world with many of those and as they can evolve, they occasionally just acquire the right properties to multiply by hijacking a host, who becomes not too ill to spread the multiplied organisms to other hosts. The disruption and suffering this can generate needs no further explanation now. We have means to defend ourselves using our immune system, assuming we do not die. Other than that, there are vaccines and antiviral medicines. When an infectious agent attacks these are not always available and need to be developed fast. The question is how to do that.Is there an incentive for private enterprise?Traditionally only state vaccine producers made the traditional vaccines for diseases like tetanus, smallpox, whooping cough and diphteria. From the 1990’s research and production of new vaccines was privatized and fell in the hands of several large pharmaceutical firms. Although it is difficult to know if this transition speeded up the development of new vaccines it did happen, with measles, mumps, hepatitis, meningococcal disease, and HPV as the first vaccine preventing cancer. The hope of potential treatment of cancer by vaccines led to much activity by startups, but no current therapeutic success.The national vaccine producers rapidly melted away. In the Netherlands the state vaccine factory needed an update of the facilities costing 3M euro and this was considered excessive by the ministry of health, after which the whole organization was sold to an Indian company. The national institutes have in many countries become purchase managers of vaccines and have lost expertise beyond negotiating skills about price and quality with foreign suppliers.After a year of corona and extraordinary gains for the companies that made the vaccine, the enthusiasm of private enterprise appears unlimited and the willingness of investors to pump money in the field endless. In many ways we have been extraordinary lucky that the companies working on mRNA vaccines were funded to find vaccines against cancer antigens. However, we cannot call luck preparedness and although it worked this time by accident does not mean we are well prepared. Preparation for another, perhaps much worse attack requires a fundamentally different approachTo be prepared a military organizational mindset is necessary. This means an organization that develops scenarios practices them in all aspects even though they may never happen. A commercial organization driven by shareholder value, as currently all health care companies, is unable to cope with this. For instance, the problems with distribution of vaccines that were produced in one country in bulk, filled in another and distributed in a third was only a small rehearsal what may happen in a more serious epidemic, when infrastructure is collapsing. Manufacturing capacity with redundant facilities, that are kept up to date but remain unused perhaps (and hopefully!) for decades are expensive and will of course either be used for something else or slowly abandoned in some cost-cutting operation when everyone has forgotten 2021.Why is there no antiviral army?This question has been asked before by several, particularly Bill Gates in a TED talk in 2015 (https://www.ted.com/talks/bill_gates_the_next_outbreak_we_re_not_ready/transcript?language=nl). But this question must be asked again. We maintain complex technical gear like F35 JSF planes or Patriot anti-missile batteries. Military professionals practice with them, maintain them and most equipment (and the personnel) will reach the end of their technological life without ever having been used against an enemy. They are maintained by the state and paid by taxes. For antiviral defense we make use of existing commercial facilities and that has now been shown to be far from ideal.Our viral defense is not under any central command. Governments cannot order the private partners to do certain research, only stimulate by grants. Companies can and will subsequently shield their know how on production -perfectly acceptable in virological peace time but currently costing lives. Yet, the development of the vaccines has been phenomenally fast, and these developments have been for a large part been driven by private enterprises.Can this be done better?Countries have nationalized armies and should have national organizations for the management of infectious attack. Although they should not be run by the military, they should have a military mindset making use of the typical expertise in the army. This concerns scenario planning, and operational readiness for different scenarios including people and material. So pandemic preparedness is not an academic institute that write reports – as has been suggested in some countries – but an organization with a large budget, and actual material and staff.Specifically, there must be testing laboratories and a factory to produce testing materials fast that can be operational within a week. Each country requires a modular vaccine factory that must be kept up to date with regard to manufacturing equipment and pre and postproduction facilities like filling lines. A chemical synthesis and production facility with formulation capacity for antivirals is essential because it is not known beforehand if vaccination will work. Finally clinical trial facilities, both for early and later phases should be kept at readiness with sufficient extra capacity to start testing vaccines and treatments immediately.The required professionals may be difficult to find and motivated to spend their careers practicing something that may never happen-but there are examples how this can be solved. In the Netherlands surgeons in hospital practice get additional defense contracts and training and are partly paid by the government for military missions where they can be deployed immediately. The advantage is that a surgical team has additional capacity in peacetime and the staff member can be missed when deployed. This could also be done for virologists, biotechnology and pharmacy experts and clinical pharmacologists.In virological peace time these facilities can collaborate and standardize (like the military in NATO) by sharing production protocols and participate in staff training and exercises.Trials in virological wartimeThe clinical pharmacologist will be essential in the planning and execution of clinical trials. In peacetime protocols for early studies with anti-infectious agents and vaccines can be set up and pre-approved by regulators. This approach has been describes earlier in BJCP. (1). Additionally we have recently shown that vaccine trials can be sped up considerably by mobile trial units setting up in hot-spot infection areas (2). Such approaches require trained staff and ready technology, and this can only be developed in virological peacetime-an ideal task for the clinical pharmacologist.Financing the systemA system like this is expensive and can only be financed by governments. For a country like the Netherlands it would cost little more than a new guided missile frigate or a F35-JSF fighter plane. Private enterprise is unsuitable as there would be no return on investment in the classical financial sense. The systems will likely be unused for a very long time but would not be useless as they can pioneer new and flexible production or research methods. Just like a classical potential enemy can be spotted by intelligence services the antiviral army will use epidemiological intelligence to determine the next threat and prepare for it.An antiviral defense like this cannot be established haphazardly and will require careful study of all different aspects. Our current pandemic may be only a weak prelude to the next one when public services may collapse. The Janssen Vaccines factory that produces vaccine for the USA is located about 1 m under sea level in Leiden. When the people who maintain the pumps are all disabled by a new illness the factory will flood. Considerations about the defense will therefore be wide ranging and go beyond what the scientific community can muster. Pandemic preparedness should start with a wide-ranging international study about what is required but should be operationalized in national levels with the aim to make all countries or regions as self-sufficient as possible. The current inequalities in vaccination across the world are a shameful reminder of the lack of organized preparedness.In 1953 the South-West of the Netherlands was flooded during a storm and about 2000 people died. This led to the Delta works- a nationally funded engineering project that goes on until today and protects the country against recurrence of this disaster. The enormous system of dams can be seen from space and requires continuous maintenance. (http://www.deltawerken.com/English/10.html?setlanguage=en) and costs about 2% of the GNP. Corona killed 18.000 people in the country and millions worldwide. To spend such amounts on viral defense appears reasonable and would make dealing with the next pandemic in a much more efficient manner feasible. A military mindset is required and there is no place for private enterprise, just like for the rest of our national defense. The testing of new health care interventions will be a large part of such preparedness organizations and the clinical pharmacologist has the right expertise to be an important contributor to the planning and execution of this new essential defense force.References1. van der Plas JL, Roestenberg M, Cohen AF, Kamerling IMC. How to expedite early phase SARS-CoV-2 vaccine trials in pandemic setting - a practical perspective. Br J Clin Pharmacol. 2020;0–3.2. Johan L. van der Plas MD1 2, PhD1 MJ van E, Ingrid M.C. Kamerling, PhD1 2, PhD1 AFCM. Accelerating vaccine trial conduct in a pandemic with a hot spot-based inclusion strategy using trial and epidemic simulation. Clin Transl Sci. 2021;

A species presence within its geographic range can be influenced by environmental variables and disturbance history, resulting in particular occupancy patterns. Understanding the factors affecting occupancy is essential to evaluate the impact of human activities on species and design conservation or restoration measures. For tropical vertebrates, there is little understanding of how multiple factors influence occupancy and interactions with other species under different conditions and disturbance levels. In this study, we evaluated how natural and human-mediated factors determine the presence of mammals and terrestrial birds in two tropical landscapes that share some species but differ in the type of ecosystems and the degree of human disturbance. We adjusted single-season occupancy models for each species to assess the key variables (human-influenced and natural) determining its presence in each landscape, and co-occurrence models to evaluate potential inter-specific relationships. Although species richness was similar between landscapes, small, generalist species had a higher occupancy in the more disturbed landscape (ψ 0.58 Vs 0.40), while larger species had a higher occupancy in the less disturbed one (ψ 0.79 Vs 0.21). Species in the more fragmented and altered landscape were mainly affected by human-mediated variables, although the effect was not always negative, with smaller species being favored by such conditions. In contrast, in the less altered landscape, environmental variables were more determinant of vertebrate occupancy. Additionally, the number, magnitude, and direction of species interactions usually changed from one landscape to another. Results from this study contribute to the broader understanding of the mechanisms that determine vertebrate occupancy in tropical ecosystems. They confirm how human disturbance can have a direct effect on occupancy of larger species of mammals, and demonstrate how in more altered ecosystems factors associated with human presence may become more limiting or more beneficial than natural ones becoming the primary determinants of occupancy.

Introduction: Some studies have indicated that adiponectin gene polymorphisms are related to coronary artery disease, and they play a role in the stabilization of atherosclerotic plaques. In this study, acute coronary artery disease patients who had a myocardial infarct with ST-elevation, chronic coronary artery disease patients who had a coronary artery bypass graft operation, and the control group with normal coronary arteries were compared for the adiponectin gene polymorphisms. Material and Methods: One hundred patients who had a myocardial infarction with ST-elevation (Group1), 100 patients who had a coronary artery bypass graft operation (Group2), and as the control group, 100 patients who had coronary angiography due to suspected coronary artery disease (CAD) and appeared to have normal coronary arteries (Group3) were included in the study. Adiponectin gene polymorphisms (rs 1501299; +276 G > T, rs2241766; +45 T > G) of the participants were determined using real-time polymerase chain reaction method. Results: The number of mutant GG base pairs of adiponectin at rs2241766 were smaller in Group 2 when compared to Group 1 and Group 3, and the difference was statistically significant (p=0.0001). Although the G allele frequencies of adiponectin at rs2241766 were similar in Groups 1 and 3 (p>0.05), the G allele frequencies in Group 2 were smaller when compared to Groups 1 and 3, and the difference was statistically significant (p=0.0001). The comparison of all groups for adiponectin rs1501299 polymorphisms and allele frequencies did not yield statistically significant results (p>0.05). Conclusion: Since adiponectin, which is thought to play a role in the stabilization of atherosclerotic plaques, has different genotype distributions and allele frequencies at rs2241766 in acute and chronic coronary artery disease, we suppose that this polymorphism can be interpreted as a risk factor.

Background: Pediatric patients with hematologic malignancies are susceptible to invasive mould sinusitis (IMS). IMS is a rare entity that requires careful attention and prompts management due to its high mortality. Methods: This is a retrospective analysis of pediatric patients with hematological malignancies treated at Children Cancer Hospital Egypt through the period from 2008 till 2016 with proven IMS. Results: Thirty-four patients were diagnosed with IMS. Five 5(15%) patients had an invasive rhino-cerebral fungal disease. Mucormycosis were isolated in 17(50%) patients, Aspergillosis in 13 (38%) patients, and mixed fungal in 4 (12%) patients. Sinuses were the only localized site in (45%). Extra-nasal spread was reported in 20 patients; Sino-pulmonary in 12(35%), Sino-cerebral in 5(15%), and Sino-orbital in 2(5%) patients. Combined antifungal therapy with surgical debridement was done in 59% of patients with a better outcome when compared to those who received only medical antifungal treatment (P = 0.01). The overall mortality rate at week 12 was 35% (12 patients), and IMS attributable mortality was 20% (7 patients). IMS with cerebral extension carried the highest mortality rate for both 12-week all-cause (p=0.04) and fungal-attributable (P=0.01) mortality. Conclusions: Pediatric patients with hematologic malignancies are susceptible to invasive mould sinusitis (IMS). Surgical debridement, combined with antifungal therapy, improves outcomes among those patients. IMS patients with cerebral extension had a higher risk of mortality.

Support vector machine (SVM) is one of the most powerful technologies of machine learning, which has been widely concerned because of its remarkable performance. However, when dealing with the classification problem of large-scale datasets, the high complexity of SVM model leads to low efficiency or become impractical. Due to the sparsity of SVM in the sample space, this paper presents a new parallel data geometry analysis(PDGA) algorithm to reduce the training set of SVM, which helps to improve the efficiency of SVM training. The PDGA introduce mahalanobis distance to measure the distance from each sample to its centroid, and based on this, define hyperellipsoid spatial density to help remove dense redundant data. When further reducing the training set, cosine angle distance analysis method is proposed to determine whether the samples are redundant data, to ensure that the valuable data are not removed. Different from the previous data geometry analysis methods, the PDGA algorithm is implemented in parallel, which leading to substantial saving in the computational cost. Experimental results on artificial dataset and 6 real datasets show that the algorithm can adapt to different sample distributions, significantly reduce the training time and memory requirements without sacrificing the classification accuracy, and its performance is significantly better than the other 4 competitive algorithms.

Background: Nursing involves “hands-on” psychomotor skills and clinical decisions in the affective and psychomotor domains which needs to be evaluate in a method that cover both domains. Through different methods of assessment objective structured clinical examination (OSCE) could be mentioned as an appropriate way for evaluating the medical students specially nursing students. objective: investigating the student’s views toward OSCE Design: A qualitative, exploratory study designed according to COREQ checklist Methods: twenty-five students who experienced OSCE exam were selected purposively. The data were collected by using semi structured interviews. The interviews were verbatim transcribed and analyzed according to the qualitative content analysis based on Graneheim and Lundman method. Results: Two main themes emerging during data analysis were: 1- Management aspects problem, that includes 3 categories: 1) supervisor’s behavior, 2) time management,3) Facilities, and 2- Educational aspects problem including three categories of 1) Simulation, 2) Educational background, 3) Question design which are key factors in conducting a more rational and helpful OSCE exam. Conclusion: results could be highly effective in promoting both clinical skills evaluation and educational programs. using more student-center methods in teaching and providing facilities to bring students to the real world of profession helping them to improve their ability in clinical decision making.

In this study, we use quantum calculus to prove Hermite-Hadamard and Ostrowski type inequalities for s-convex functions in the second sense. The newly proven results are also shown to be an extension of comparable results in the literature, like the results of [1, 12, 16]. Furthermore, it is provided that how the newly discovered inequalities can be applied to special means of real numbers.

In this paper, we establish global conservative solutions of the two-component $\mu$-Hunter-Saxton system by the methods developed in “A. Bressan, A. Constantin, “Global conservative solutions of the Camassa-Holm equation,” Arch. Ration. Mech. Anal. 183(2), 215-239 (2007)” and “H. Holden, X. Raynaud, “Periodic conservative solutions of the Camassa-Holm equation,” Ann. Inst. Fourier (Grenoble) 58(3), 945-988 (2008)”.

Objective: The aim of this retrospective study is to evaluate the cortical and trabecular mandibular bone morphology of children and adolescents who have type 1 diabetes mellitus (DM) and controls by using fractal dimension (FD) analysis and different panoramic radiomorphometric indices through digital panoramic radiographic images (DPRIs). Methods: The study included total 114 patients(57 type 1 DM-57 control). The type 1 DM group was divided into well-controlled(6,59.0) groups, according to HbA1c. The mandibular cortical width (MCW) and panoramic mandibular index (PMI) were measured, the mandibular cortical index (MCI) and simple visual estimation (SVE) were evaluated, and FD analysis of three areas of interest (IAs) was obtained in all of the DPRI. Results: There were no statistically significant differences found in any parameters when all the DM groups were compared with controls. In all the groups, significant correlation was observed between the MCW-FD values, PMI-FD values, and MCW-IA 1 FD values. Conclusions: This study revealed no cortical and trabecular bone changes in mandibula in children and adolescents with type 1 DM compared to the control group. These findings did not support the hypothesis that children and adolescents with type 1 DM may have different bone structure.

The famous singularity of number 7; conjectured by Ramanujan from a Diofanthine equation. In which the answer is given in the subtraction of 2n for every number A greater than zero, at most two solutions were obtained except for number 7, in which case 5 solutions were obtained. What was analysed by many 20th century mathematicians such as Lebesgue, Nagell, Chowla, Lewis, Skolem, Apéry, among others. That, through their demonstrations, they supported this conjecture as true. It is currently known as the Lebesgue-Ramanujan-Nagell Equation. And to this day, contemporary mathematicians continue to study it. In this article, the equation was analysed and developed in such a way that several counterexamples were reproduced, which was good for its refutation. However, this was the starting point, which extended the conjecture from the unique case of the number 7 to several numbers in which 5 solutions were obtained such as the number 28 and which should also be defined as singular. Through what will be known as the Ramanujan-Alhena Singular Number Theorem

TP53 mutation, Li-Fraumeni syndrome, is a syndrome that leads to a hereditary cancer predisposition. Here we describe the case of a 13-year-old male who presented with osteosarcoma, family history of LFS, who developed a second primary tumor of the lung. No other similar cases have been reported. After this osteosarcoma diagnosis, he had pre-operative imaging which included a PET CT Chest. This revealed a subpleural nodule in the lung of unclear etiology. After completing initial therapy, a repeat chest CT showed that the nodule persisted. Pathology revealed an acinar adenocarcinoma. This tumor is not common in pediatric LFS patients.

Alien populations keep establishing at alarming rates and often have highly detrimental impacts on recipient environments. Quantifying the magnitude of their impact is essential for prioritization and management and is commonly done by comparing ecological variables between invaded and uninvaded states. Such estimates are highly uncertain and often biased because they ignore the temporal dynamics of the system. This has hampered the understanding and prediction of impacts, and hence management. To address this, we propose a framework to quantify impacts by contrasting the trajectory of ecological variables in presence of an alien with that forecasted in the absence of the alien. We discuss how trajectories in absence of the alien can be forecasted statistically and how uncertainty in these forecasts can be accounted for when estimating impacts. This framework readily allows for comparisons of alien species' impacts across taxa and regions, as well as with impacts caused by other stressors.

We present here a very illustrative case of a rare pathology of recessive congenital methemoglobinemia. The patient, a newborn female, has the variant NM_000398.7:c.535G>A, p.(Ala179Thr) of the CYB5R3 gene in homozygosis, a variant classified as pathogenic. The reported population frequency of the allele is 0.0128%, reason why it is remarkable to find both parents are heterozygous carriers without consanguinity. A brief review of previously published cases are presented.

A 17-year-old healthy female presented with altered mentation after a fall, workup revealed new onset APML. Chemotherapy was initiated. She developed MODS requiring ECMO and CVVHDF. Two days after discontinuation of support, patient developed acute worsening mentation, emesis, diarrhea, tachycardia, fever, creatinine of 9.58 mg/dL, and prolonged QTc-582, indicating arsenic poisoning from chemotherapy. Initial management goals are decontamination and hemodynamic stabilization. Hemodialysis can be treatment of toxicity if chelation is not an option. This is the youngest patient to receive hemodialysis for the treatment of acute arsenic toxicity in the literature who was not hemodialysis dependent.

Background: Chemotherapy suppresses the immunoglobulin production due to the cell toxicity. Decreased immunoglobulins levels results in opportunistic infections. Assessment of immunoglobulin G (IgG) serum levels against selected vaccine-preventable diseases (VPD) before and 6 months after chemotherapy (AC) in a group of Iranian cancerous children. Methods: Serum levels of Rubella, Diphtheria toxin, Hepatitis B virus (HBV), Tetanus Toxoid, Mumps and Measles IgGs of were measured among 30 previously vaccinated malignant children. Six months AC, IgG serum levels were retested to compare with the before treatment concentration. Results: 17 (56.7%) individuals were male and the age mean±SD = 7.69±3.09 (3-15 years). The most frequent malignancy was ALL (56.7%). Rubella IgG was decreased from 73.88±85.11 to 56.59±72.84 IU/mL (P< 0.05; r= 0.956; 33.4% became negative AC (NAC), Diphtheria toxin IgG was diminished from 0.683±0.454 to 0.174±0.248 IU/mL (P< 0.05; r= 0.601; 26.7% NAC); Anti-HBV IgG was reduced from 46.26±101.56 to 25.56±80.49 IU/mL (p< 0.05; r= 0.524; 60% NAC) and Anti-Tetanus Toxoid IgG was fall down from 1.031±0.582 to 0.321±0.408 IU/mL (p< 0.05; r= 0.365; 33.4% NAC). Anti-Measles and Anti-Mumps IgGs were not significantly changed (p> 0.05). Conclusion: Pediatric chemotherapy was associated with diminished IgG serum levels of most VPD. Quantitative estimations showed that: when the higher or lower IgG exists before chemotherapy, the higher and lower levels remain 6 months after treatment, respectively. Revaccination program is suggested against opportunistic infectious threats in Iranian pediatrics suffering cancer and undergoing chemotherapy. This approach enhances their survival and quality of life.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide with its different variants. The transmission efficiency of the new variants is much higher than the existing ones. Therefore, developing new preventive measures based on the transmission routes of the virus is needed to limit the spread. The possible transmission routes include direct contact with surfaces contaminated with droplets secreted by patients and airborne viral transmission from person to person. Thermal inactivation is a preventive measure that applies high temperature to objects or fluids, as has been reported previously. However, inactivation data of aerosolized SARS-CoV-2 exposed to heat for a short time at high temperatures are not in the literature yet. We evaluated the inactivation of the aerosolized virus while passing through an electric heater. The virus inactivation test experiments were conducted at two temperatures of the heater’s outlet air, 150±5oC, and 220±5 oC, at an air flow rate of 0.6 m3/h (10 L/min) and heat exposure time of 1.44 s. The loss in viability of the virus at 150 oC and 220 oC was measured as 99.900% and 99.999%, respectively. The results indicate that the high-temperature inactivation of SARS-CoV-2 may potentially reduce aerosolized viral indoors.

We consider the following fourth-order nonlinear Schr{\”o}dinger equation(4NLS) \begin{align*} (i\partial_t+\varepsilon\Delta+\Delta^2)u=c_1u^m+c_2(\partial u)u^{m-1}+c_3(\partial u)^2u^{m-2}, \end{align*} and establish the conditional almost sure global well-posedness for random initial data in $H^s(\mathbb{R}^d)$ for $s\in (s_c-1/2,\ s_c]$ when $d\geq3$ and $m\geq5$, where $s_c:=d/2-2/(m-1)$ is the scaling critical regularity of 4NLS with the second order derivative nonlinearities. Our proof relies on the nonlinear estimates in a new $M$-norm and the stability theory in the probabilistic setting. Similar supercritical global well-posedness results also hold for $d=2,\ m\geq4$ and $ d\geq3,\ 3\leq m<5$.

Abstract Purpose: To evaluate our learning curve of pediatric totally thoracoscopic lobectomy (TTL), we review the safety and efficiency of our initial experiences with TTL on pediatric patients with congenital lung malformation. Materials and Methods: This was a retrospective study of all the pediatric patients undergoing TTL between March 2011 and January 2017. Cumulative summation (CUSUM) analysis of operative time (OT) was used. Results: One hundred and three patients were retrospectively analyzed and were divided chronologically into two phases, ascending phase (A) and descending phase (B), through CUSUM of OT. Phases A and B comprised 52 and 51 cases, respectively. OT decreased significantly from phases A to B (P < 0.05). No significant differences were observed in the demographic factors (except for age and body weight) and the conversion or the complication rates between the two phases. Six cases were converted to open surgery (5.8%). Four conversions occurred within the first third of the series and two in the last third. There were no mortalities. Conclusions: Repeated standardized training play a role in overcoming the learning curve for totally thoracoscopic lobectomy in children, and CUSUMOT indicates that the learning curve of around 52 cases is required in our institute.

Aims: Little is known about usual care by physicians and pharmacy teams to support adherence to statins and whether the extent of this care is associated with adherence to statins. Objective of the study was to examine the relationship between the extent of adherence supporting activities of HCPs and patients’ adherence to statins. Methods: Cross-sectional study in 48 pharmacies and affiliated physicians’ practices, between September 3, 2014 and March 20, 2015. Patients visiting the pharmacy with a statin prescription from participating prescribers were invited to participate. Usual care to support adherence was assessed among HCPs with the Quality of Standard Care questionnaire about usual care activities to support adherence. Adherence to statins was assessed among patients with the MARS-5 questionnaire. The association between the extent of HCPs’ adherence supporting activities and patients’ adherence was examined by means of multilevel regression analysis. Results: 1,504 patients and 692 HCPs (209 physicians, 118 pharmacists and 365 pharmacy technicians) participated. No association was found between the extent of physicians’ adherence supporting activities and patients’ adherence to statins. The extent of adherence supporting activities by pharmacy teams in usual care was negatively associated with patients’ adherence to statins (B coefficient -0.057 (95%CI: 0.112-0.002). Conclusions: This study suggests that there is no positive relationship between the extent of HCPs’ adherence supporting activities in usual care and patients’ adherence to statins. Other methods than questionnaires (e.g. electronic monitors (to assess adherence) and observations (to assess usual care) should be applied to confirm the results of this study

The tomato hind Cephalopholis sonnerati (Valenciennes) (Serranidae), belonging to the genus Cephalopholis, is a bottom dwelling coral reef of 12–120-m depth in the Indo-Pacific and Red Sea. C. sonnerati has also been characterized by complex social structures and behavioural mechanisms. However, due to the lack of genomic resource for C. sonnerati, molecular-genetic studies and genomic breeding remain unexplored in this species. In this study, we reported the chromosome-level genome assembly of C. sonnerati using PacBio sequencing and Hi-C sequencing technologies. We obtained a total length of 1043.66 Mb with an N50 length of 2.49 Mb, containing 795 contigs assembled into 24 chromosomes. Overall 95.8% of the complete BUSCOs were identified in the assembled genome, suggesting the completeness of the genome. Then, we predicted 26,130 protein-coding genes, of which 94.26% were functionally annotated. In addition, C. sonnerati diverged from its common ancestor with E. lanceolatus and E. akaara approximately 41.7 million years ago. Finally, we found tissue-specific expression of 8,108 genes. Functional analyses showed that they mainly consisted of complement and coagulation cascades, DNA replication, synaptic vesicle cycle, long-term potentiation and other glycan degradation. Furthermore, comparative genome analyses indicated that the expanded genes families were highly enriched in the sensory system, which was different from the enrichment analysis of the tissue-specific expression genes. In brief, to our knowledge, we reported the first chromosome-level genome assembly of C. sonnerati, which will provide a valuable genome resource for studies on the genetic conservation, resistance breeding, and evolutionary of C. sonnerati.

Rationale: The aim of this study was to use the clinical practice guidelines issued by the Quebec provincial government to assess the diagnosis and management of childhood obesity in a Canadian academic family medicine teaching unit (FMTU). Methods: We performed an audit of diagnosis and care of childhood obesity in a FMTU in the province of Quebec. We used the clinical practice guidelines established by the Quebec government’s Institut national d’excellence en santé et en services sociaux (INESSS) which include use of the World Health Organization (WHO) growth chart for diagnosing childhood obesity. We analyzed the electronic medical records of every child from 5 to 12 years old who had a medical appointment at the FMTU in 2017 (n=618). We audited whether childhood obesity had been correctly diagnosed according to the WHO growth chart and if the medical care that followed was adequate according to INESSS guidelines. Results: We identified 71 children as obese according to the WHO chart, of whom 40 (56%) had been diagnosed as such by clinic health professionals. Of these 40, (33) 83% received nutritional counseling, (33) 83% received physical activity counseling, (13) 33% had parent’s involvement counselling, (19) 48% were referred to another health professional (e.g., dietician, psychologist, kinesiologist) and (12) 31% were followed up within six months. Only 7 (18%) patients received all INESSS’s recommendations. Conclusions: Our study shows that childhood obesity remains under-diagnosed in Canadian primary care, even in an academic teaching environment. This affects the quality of care delivered to these patients. Moreover, even if childhood obesity had been correctly diagnosed, management of this clinical condition is still incomplete. Understanding barriers and facilitators to diagnosing and managing childhood obesity is necessary to improve the quality of care on a larger scale.