Organisms use color to serve a variety of biological functions, and these functions can be revealed by examining patterns of color variation across geographic and biological gradients. This approach, however, presents a data collection trade-off whereby researchers must either maximize intraspecific detail or taxonomic and geographic coverage. This limits our ability to fully understand color variation across entire taxonomic groups at global scales. We provide a solution by extracting color data from 47,000 individual specimens of ants, representing 10,000 species, using a computer vision algorithm. Our analyses on this dataset reveal that ants are dominated by variation in the dark-pale spectrum, that half of this variation is held within species, and that, overall, ant specimens tend to be darker in colder environments. Similar approaches may unlock a vast amount of data residing in museum and specimen databases and establish a digital platform for a data collection revolution in functional biogeography.

SARS-CoV-2 are enveloped RNA viruses that belong to the family Coronaviridae of genus Beta coronavirus, responsible for the COVID-19 pandemic. The mutation rate is high among RNA viruses and in particular, coronavirus replication is error prone with an estimated mutation rate of 4x10-4 nucleotide substitutions per site per year. Different variants of SARS-CoV-2 have been reported from various countries including United Kingdom, South Africa, Denmark and Brazil. These variants were evolved due to mutations on spike gene responsible for the synthesis of spike (S) protein of SARS-CoV-2. These variants / lineages from different countries were designated as cluster 5 or SARS-CoV-2 variant of Denmark, B.1.351 lineages or 501.V2 variant or SARS-CoV-2 variant of South Africa, lineage B.1.1.248 or lineage P.1 of Brazil and lineage B.1.1.7 or Variant of Concern (VOC) 202012/01 from United Kingdom. Due to mutations in S gene, the variants acquired changes in S protein resulting in increased transmissibility of the mutated virus. As on date, alterations in virulence or pathogenicity have been reported from these lineages, from many parts of the globe. In our opinion, since the S protein is significantly altered, the suitability of existing vaccine targeting the S protein of SARS-CoV-2 variants is a major concern. We also presume that the mutations in SARS-CoV-2 is a continuous and evolving process that may result in the transformation of naïve SARS-CoV-2 into totally new subsets of antigenically different SARS-CoV-2 viruses over a period of time.

We herein report a rare case of Wilson disease in a 9 years old girl, diagnosed incidentally while investigating the cause of deterioration of condition even after standard of care for Brucellosis. The case provides a glimpse on intricacy of diagnosing Wilson disease in a child with superimposed infection.

Premature ovarian insufficiencysecondary to COVID-19 infection: an original case reportShortened title: COVID-19 induced premature ovarian insufficiencyDr James Wilkins1Email address: james.wilkins2@nhs.netTelephone: +447564 977847Address: Department of Obstetrics and GynaecologySouth Tyneside & Sunderland Royal HospitalSouth ShieldsNE34 0PL United KingdomDr Shamma Al-Inizi2Email address: shamma.al-inizi@stft.nhs.ukTelephone: +447821 708743Address: Department of Obstetrics and GynaecologySouth Tyneside & Sunderland Royal HospitalSouth ShieldsNE34 0PL United Kingdom1 Foundation doctor in the department of Obstetrics and Gynaecology, South Tyneside & Sunderland NHS Foundation Trust, United Kingdom2 Consultant Obstetrician and Gynaecologist, Department of Obstetrics and Gynaecology, South Tyneside & Sunderland NHS Foundation Trust, United KingdomMain DocumentBackground:In late December 2019, several patients began to develop signs and symptoms consistent with a viral pneumonia in Wuhan, China. This disease spread, becoming a global pandemic and was eventually identified to be a novel strain of coronavirus termed coronavirus disease 2019 (COVID-19). A significant proportion of patients infected with this virus unfortunately develop severe disease associated with acute respiratory distress syndrome, hypercoagulability and neurological disease amongst other complications(1) and, as of the 16/2/21, there have been 108.7 million cases and 2.4 million reported deaths globally(2). There is increasing recognition that a proportion of patients who contract this acute infection will develop a subsequent long-term illness. The range of symptoms attributed to this is large but most commonly include fatigue, shortness of breath and myalgia(3). This long-term illness is thought to be secondary to chronic tissue inflammation. There is a risk that reproductive tissue may also be vulnerable, potentially resulting in subfertility, but to date no cases of deranged ovarian function secondary to COVID-19 have been reported.Case report:A 34-year-old lady presented to the fertility clinic at South Tyneside District Hospital in November 2020 with primary subfertility after having regular unprotected sexual intercourse for over one year. She and her partner were investigated for this; a hysterosalpingogram demonstrated patent fallopian tubes and her partner’s seminal fluid analysis was normal. Ovarian function was investigated with blood tests. These demonstrated high gonadotrophin levels and a very low progesterone level of 0.3nmol/L consistent with premature ovarian insufficiency (POI). The common causes of this were investigated but none were identified, nor did she have a positive family history of POI. Polycystic ovarian syndrome was excluded due to a normal transvaginal ultrasound scan and lack of clinical and biochemical evidence of hyperandrogenism. She was a non-smoker with a healthy BMI, had had neither pelvic surgery nor chemo/radiotherapy previously. In terms of comorbidities, she was fit and well other than well controlled hypothyroidism, which was medicated with levothyroxine with a recent TSH of 0.98mUI/L, in the normal range.Interestingly, this lady was diagnosed with COVID-19 in April 2020 by a nasopharyngeal swab demonstrating positive viral serology. During the acute illness she developed symptoms of shortness of breath, fatigue, myalgia and headache but did not require hospitalisation nor active treatment for these symptoms. Her shortness of breath improved over the course of two to three weeks but she experienced persistent fatigue and continuing myalgia over the next few months. She has been referred to the long COVID clinic due to this. In addition, her periods became irregular with oligomenorrhoea and she began to experience regular hot flushes and night sweats. Two months prior to contracting COVID-19, in February 2020, she was referred to the fertility clinic and at this time she had normal regular periods and normal gonadotrophin levels: FSH 8U/L and LH 2U/L. However in November 2020, seven months after her acute infection, her FSH was 78U/L and LH 43U/L and on repeat two months later her gonadotrophins were persistently raised: FSH 89U/L and LH 32U/L.These events mean that this lady is very unlikely to fall pregnant without support and one of the available options is trying to conceive via assisted reproduction with egg donation or adoption, hence a referral to the local IVF centre was arranged.Due to the novel nature of this presentation, written consent to publish this case was obtained from the patient.Discussion:It is well established that viruses can cause inflammation of reproductive tissue; indeed one of the most common clinical manifestations of mumps is orchitis, which can be damaging to testicular function. Further, several case reports have discussed the development of orchitis in patients who have contracted COVID-19 and small studies have shown pathological changes to testicular tissue in some affected with this virus(4). A possible mechanism for this is expressed in Figure 1. Reproductive tissue expresses the ACE2 receptor and COVID-19 may utilise this to gain cellular entry(5, 6). Viral entry to these cells would promote an inflammatory response through the complement cascade and associated chemotaxis, phagocytosis of virally infected cells and presentation of this antigen causing local T cell activation and cytokine release by a myriad of immunological cells(7). These effects have the potential to cause significant cellular demise either directly through apoptosis and phagocytosis or indirectly through mechanisms such as the disruption of tissue microvasculature(7). These could cause sufficient damage to impair steroidogenesis and ovulation affecting fertility.Despite this mechanism and positive histological findings in males, to date these studies have not found these microscopic changes in ovarian tissue following infection with COVID-19 nor have there been case reports describing an effect of COVID-19 on female sex hormones or fertility. This may be due to several factors. Firstly, the ACE2 receptor is less expressed in ovarian tissue compared to testicular tissue(8) meaning the change of viral invasion to this tissue and subsequent damage may be less. Another explanation may be that there have been very few studies examining ovarian tissue histologically following COVID-19. This means it is very possible an effect of COVID-19 on this tissue may have thus far gone undetected. In addition, investigation of subfertility is normally only undertaken following a minimum of one year of regular unprotected sex. As the pandemic began to spread worldwide in early 2020, it is likely that if COVID-19 were to impact on the ovarian function of a significant proportion of women then the impact of this would not be investigated until early 2021 and therefore would not begin to be apparent until this time.The COVID-19 pandemic is the largest health challenge the world has faced in modern times with many people already having been infected by this virus. The possibility that a cohort of women may have contracted thus far undiagnosed COVID-19-induced subfertility with more at risk of developing this, means that health professionals working in fertility should be highly alert to this potentiality and more work should be performed to investigate this further. If more evidence is gathered consistent with this hypothesis, then a lower threshold for treatment aiming to reduce inflammation to protect ovarian function should be considered and women should be made aware of this risk.Word count: 1025 words.DeclarationsWe have no conflicts of interest related to this publication to declare and there has been no financial support for this work. The finished publication has been reviewed and approved for submission by all corresponding authors. Written consent for this case report has been obtained from the patient and as this work is a case report formal ethical approval was not required.Contribution to authorshipPrimary Author: Dr James Wilkins (JW)JW assessed the patient about whom this case report is detailed in clinic alongside SAI and, following this, planned this case report, assessed the background literature and hypothesised a potential mechanism for the association described. Following this, JW wrote up this work with contributions from SAI.Secondary Author: Dr Shamma Al-Inizi (SAI)SAI was the primary assessor of this lady in her subfertility clinic and suggested the case would merit publication, encouraging JW with this. SAI then reviewed the work produced by JW making changes and suggestions as appropriate in the writing up process before giving her approval for submission.Figures:Figure 1: Possible mechanism of COVID-19 induced premature ovarian insufficiencyReferences:1. Public Health England. COVID-19: epidemiology, virology and clinical features. 2021.2. World Health Organisation. Coronavirus disease (COVID-19) pandemic, Available at: .3. Iacobucci G. Long covid: Damage to multiple organs presents in young, low risk patients. BMJ. 2020;371:m4470.4. Madjunkov M, Dviri M, Librach C. A comprehensive review of the impact of COVID-19 on human reproductive biology, assisted reproduction care and pregnancy: a Canadian perspective. Journal of Ovarian Research. 2020;13(1):140.5. Hoffmann M, Kleine-Weber H, Schroeder S, Krüger N, Herrler T, Erichsen S, et al. SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell. 2020;181(2):271-80.e8.6. Henarejos-Castillo I, Sebastian-Leon P, Devesa-Peiro A, Pellicer A, Diaz-Gimeno P. SARS-CoV-2 infection risk assessment in the endometrium: viral infection-related gene expression across the menstrual cycle. Fertil Steril. 2020;114(2):223-32.7. Murphy K, Weaver C. Janeway’s Immunobiology. 9 ed: W. W. Norton & Company; 2017 2017. 928 p.8. Hikmet F, Méar L, Edvinsson Å, Micke P, Uhlén M, Lindskog C. The protein expression profile of ACE2 in human tissues. Molecular Systems Biology. 2020;16(7):e9610.

Objective: To evaluate the maternal, perinatal and neonatal outcomes for pregnant women having tested positive for COVID-19 with the reverse transcription polymerase chain reaction (RT-PCR) technique. Design: Retrospective study. Setting: University‐affiliated hospital. Population: Pregnant women with confirmed COVID-19 infection. Methods: PCR tests were administered to the women presenting with clinical complaints indicative of suspected COVID-19, or admitted to the hospital for obstetric reasons. The present study used clinical records to collect data such as general characteristics, clinical signs and symptoms, laboratory findings and radiological imaging results of the pregnant women, as well as the types of delivery and RT-PCR data of the newborns from the women who gave birth. Main outcome measures: Data related to the courses of pregnancy, maternal symptoms, types of delivery, and neonatal outcomes. Results: 523 pregnant women tested positive for COVID-19 with RT-PCR technique. Of these pregnant women, 411 had asymptomatic while 112 women showed at least one symptom. Of the 523 pregnant women in total, 384 maintained their pregnancies. Eventually, 135 women gave birth. Twelve pregnant women (2.2%) in total were treated in the intensive care unit, and three (0.6%) died with COVID-19. All the newborns tested with the RT-PCR technique. All the test results were negative. Conclusion: The existing data show that pregnant women with COVID-19 infection may need to be admitted to intensive care, and they may even be under a serious risk of maternal morbidity which may result in maternal death. Funding: None

An 8-year-old girl with a low platelet count was diagnosed with immune thrombocytopenia (ITP) but responded poorly to 17 days of first- and second-line treatment. During the period of treatment, the potential causes of ITP in children were searched, especially infections which are the most common cause of ITP in children. Finally, she was diagnosed with Hashimoto’s thyroiditis, and the platelet count recovered on the 3rd day of levothyroxine treatment and remained normal in follow-up. No case of Hashimoto’s thyroiditis associated with newly diagnosed paediatric ITP has ever been reported.

BACKGROUND AND PURPOSE We aimed to develop a dosage form comprising of Capecitabine loaded carbon nanotubes for its targeted delivery to the colon. EXPERIMENTAL APPROACH Single walled carbon nanotubes (SWCNT) were functionalized by -COOH and chitosan along with folic acid. Capecitabine was loaded in these SWCNT’s and the system was analyzed by FTIR, SEM, Raman spectroscopy. Percent drug loading was assessed and the cytotoxicity (COLO320DM and HT29) was verified by using MTT and SRB assay. The apoptosis study was carried out by flowcytometry. The system was enclosed in enteric coated capsule with pH sensitive polymers and characterized for invitro disintegration, dissolution and invivo roentgenographic studies. KEY RESULTS FTIR, Raman and XRD studies indicated the confirmation of attachments, whereas SEM exhibited size range of 200-500 nm. Drug loading capacity was observed to be 94.63±1.07 %. Cytotoxicity studies of Capecitabine and FA–CHI-F-SWCNT-Capacitabine against COLO320DM by using MTT assay showed that FA–CHI-F-SWCNT-Capacitabine exhibited 86.45±0.5788% inhibition whereas pure Capecitabine showed 50.52±0.3106% inhibition. Against HT29, the % inhibition was observed to be 82.76±0.4668 % and 56.41±0.2316 % respectively for FA–CHI-F-SWCNT-Capacitabine and pure Capacitabine. In case of SRB assay of COLO320DM, the FA–CHI-F-SWCNT-Capacitabine exhibited 89.62±0.4095 % inhibition and Capecitabine showed 84.36±0.2559% inhibition, whereas against HT29, FA–CHI-F-SWCNT-Capacitabine showed 81.36±0.2958 % inhibition and Capacitabine exhibited 90.62±0.4196 % inhibition. CONCLUSION AND IMPLICATIONS FA-CHI-FSWCNT loaded system exhibited better cytotoxicity compared with pure drug, Invivo studies revealed that the prepared capsule formulation remains intact in the stomach thereby preventing drug release in the gastric milieu to achieve targeting in colon.

Settlement and metamorphosis of planktonic larvae into benthic adults is a critical part of a diverse range of marine invertebrate-mediated processes such as the formation of mussel beds and coral reefs, the recruitment of marine shellfisheries and the initiation of macrobiofouling. Although larval settlement and metamorphosis induced by natural chemical cues is widespread among marine invertebrates, their mechanisms of action remain poorly understood. Here, we identified that the molecular target of adenosine (an inducer of larval settlement and metamorphosis from conspecific adults in the invasive biofouling mussel Mytilopsis sallei) is adenosine kinase (ADK). Results of transcriptomic analyses, pharmacological assays, temporal and spatial gene expression analyses, and siRNA interference, suggest ATP-dependent phosphorylation of adenosine catalyzed by ADK, activates the downstream AMPK-FoxO signaling pathway, inducing larval settlement and metamorphosis in M. sallei. This study not only reveals the role of the ADK-AMPK-FoxO pathway in larval settlement and metamorphosis of marine invertebrates, but also deepens our understanding of the functions and evolution of adenosine signaling which is widespread in biology.

Background: Recently there have been reports of LVAD patients presenting with multiple ineffective ICD shocks. In such patients, azygous vein coil placement by providing an alternative anterior-posterior trajectory of the electrical shock vector can enable successful defibrillation. Objective: This review provides a hands-on approach to azygous vein coil implantation. Additionally, we compare our tools and technique to those that have been previously described by other operators. Methods: From 2018 to 2021, 8 patients were identified who underwent azygous vein coil implantation at MedStar Washington hospital center using specific tools and technique. Demographic and procedural data were obtained by retrospective review of patient charts, procedure logs, fluoroscopy, and venography performed during device implantation. Results: The indication for azygous vein coil implantation was ineffective ICD shocks in 7 patients. The presenting rhythm was VF in 6/8 (75%) cases and sustained VT in 2/8 (25%) cases. Using the approach described, we were able to successfully implant an azygous vein coil in all 8 (100%) patients. There were no procedure-related complications. Post implantation, defibrillation testing (DFT) was successfully performed in 6/8 (75%) patients. One patient failed DFT testing despite the placement of an azygous vein coil. In another patient, DFT testing was not performed because the patient was in atrial fibrillation and was not systemically anticoagulated. Conclusion: Placement of an azygous vein coil in LVAD patients with failed ICD shocks using the tools and technique described in this review is safe and highly efficacious (successful in 100% cases).

Background The clinical course and therapeutic strategies in the congenital long QT syndrome (LQTS) are genotype-specific. However, accurate estimation of LQTS-genotype is often difficult from the standard 12-lead ECG. Objectives This study aims to evaluate the utility of QT/RR slope analysis by the 24-hour Holter monitoring for differential diagnosis of LQTS-genotype between LQT1 and LQT2. Methods This cross-sectional study enrolled 54 genetically identified LQTS patients (29 LQT1 and 25 LQT2) recruited from 3 medical institutions. The QT-apex (QTa) interval and the QT-end (QTe) interval at each 15-second were plotted against the R-R intervals and the linear regression (QTa/RR and QTe/RR slopes, respectively) were calculated from the entire 24-hour and separately during the day or night-time periods of the Holter recordings. Results The QTe/RR and QTa/RR slopes at the entire 24-hour were significantly steeper in LQT2 compared to those in LQT1 patients (0.262 +/- 0.063 vs 0.204 +/- 0.055, P = 0.0007; 0.233 +/- 0.052 vs 0.181 +/- 0.040, P = 0.0002, respectively). The QTe interval was significantly longer, QTe/RR and QTa/RR slopes at daytime were significantly steeper in LQT2 than in LQT1 patients. The receiver operating curve analysis revealed that the QTa/RR slope of 0.211 at the entire 24-hour Holter was the best cut-off value for differential diagnosis between LQT1 and LQT2 (sensitivity: 80.0%, specificity: 75.0% and area under curve: 0.804 [95%CI = 0.68-0.93]). Conclusion The continuous 24-hour QT/RR analysis using the Holter monitoring may be useful to predict the genotype of congenital LQTS, particularly for LQT1 and LQT2.

Objectives: Careful patient selection in septorhinoplasty is critical to good patient outcomes. Body Dysmorphic Disorder (BDD) is a known risk factor for poor postoperative satisfaction. Our aim was to refine factors influencing patient satisfaction following septorhinoplasty and identifying relative risk of BDD. Design: A prospective cohort study was conducted. All participants completed SCHNOS and BDDQ (Body Dysmorphic Disorder Questionnaire) pre- and post-operatively; both validated tools in septorhinoplasty assessment. Setting: ENT clinic, district general hospital, UK Participants: 16 patients undergoing septorhinoplasty by a single surgeon, and 32 controls. Main outcome measures: Incidence of BDD in septorhinoplasty patients compared to control group. Identifying patient groups at high risk of BDD at presentation Results and Conclusions: Mean obstructive SCHNOS score improved from 79.7 to 35.9 following septorhinoplasty (22.5 in controls), p<0.01, 95%CI [28.6-58.9] and mean cosmetic SSCHNOS from 71.9 to 29.2 (1.7 in controls), p<0.001, 95%CI [27.2-58.2]. 38% (five female and one male) screened positively preoperatively on BDDQ and 31% (four male and one female) were borderline (0% in controls). Postoperatively 19% screened positively on BDDQ; one male identified preoperatively, and two males converting from borderline to BDD. All female patients positive on BDDQ preoperatively were non-BDD postoperatively. BDDQ is a useful screening tool for patients who may be dissatisfied with septorhinoplasty outcome. Satisfaction is high in female patients overall, although they are more likely to screen positive for BDD preoperatively. Particular caution should be exercised in male patients scoring borderline or positive on BDDQ.

Demographic Characteristics associated with Food Allergy in a Nationwide Canadian StudyTo the Editor,We conducted a nationwide Canadian telephone survey on food allergy (FA) prevalence between 02/2016 and 01/2017 (SPAACE [S urveying P revalence of FoodA llergy in A ll C anadianE nvironments] to SPAACE [S2S]1], targeting vulnerable populations (New, Indigenous, and lower-income Canadians) using 2006 Canadian Census data (Appendix). We compared prevalence between vulnerable and non-vulnerable populations2 and reported (in univariable analysis) that prevalence was lower in immigrants and less-educated adults. We now examine the independent effect of these and other characteristics (age, sex, race/ethnicity, and household size) on FA.The adult household respondent completed the Food Allergy Prevalence Questionnaire (FAPQ)1,3,4 for each household member (Appendix). Food allergy was defined as perceived (self-report of any FA) or probable (self-report of a convincing history (Appendix) and/or physician diagnosis of a peanut, tree nut, fish, shellfish, sesame, milk, egg, wheat, and/or soy allergy).1,4 The Research Ethics Boards of the Universities of Calgary and Waterloo approved the study. The association between perceived and probable FA and demographic characteristics was assessed through weighted univariable and multivariable random effects logistic regressions (Appendix).Of 11,592 eligible households, 5874 completed the FAPQ (50.7% household response rate), providing data on 14,818 individuals (Table 1).In multivariable analyses, adults ≥45 years (OR 0.69, 95% confidence interval (CI) 0.56, 0.86), New Canadians (OR 0.51, 95%CI 0.38, 0.69), those immigrating to Canada ≥10 years prior (OR 0.75, 95%CI 0.62, 0.92), and those residing in larger households (OR 0.82, 95%CI 0.75, 0.90) were less likely to report any perceived FA (Table 2). Females (OR 1.49, 95%CI 1.27, 1.74) and adults with post-secondary education (OR 1.20, 95%CI 1.02, 1.43) were more likely to reportperceived FA.New Canadians (OR 0.46, 95%CI 0.30, 0.68), those immigrating ≥10 years prior (OR 0.64, 95%CI 0.49, 0.82), and those residing in larger households (OR 0.85, 95%CI 0.77, 0.94) were less likely to reportprobable FA, whereas children (OR 1.95, 95%CI 1.38, 2.75), females (OR 1.49, 95%CI 1.22, 1.82), and adults with post-secondary education (OR 1.55, 95%CI 1.23, 1.96) were more likely to reportprobable FA.In addition to many of the characteristics associated with any FA, race/ethnicity was also associated with some individual FA (Supplemental Table 1A&B).When the sample was restricted to parents with at least one Canadian-born child, Asian-born parents were less likely to report anyperceived (OR 0.40, 95%CI 0.24, 0.66) and probable FA (OR 0.29, 95%CI 0.14, 0.61) (Supplemental Table 2). However, Canadian-born children of Asian-born parents were more likely to report anyperceived (OR 1.77, 95% CI 1.13, 2.76) and probable FA (OR 2.11, 95% CI 1.29, 3.43).We have shown that while children, females, and adults with post-secondary education were more likely to report at least oneperceived or probable FA and adults ≥ 45 years, immigrants, and those in larger households were less likely to report FA, Asian and Indigenous race/ethnicity were associated with specific foods. It is likely that our observed association between FA and higher education and Canadian birthplace is attributable to increased FA awareness, better healthcare access, and differing genetic and environmental influences. The association between larger household size and decreased FA supports the hygiene hypothesis.5 Our paradoxical finding of a lower odds of FA in Asian-born parents of Canadian-born children and a higher odds of FA in Canadian-born children of Asian-born parents suggests that early life environmental exposures, such as climate, dietary, and microbial, exert a differential effect depending on genetic background.Although our nationwide sampling frame precluded food challenges and only included households with landlines and nonresponse bias may have influenced our results, we have demonstrated clear associations between demographic characteristics and FA, potentially important clues to environmental determinants.

In this paper, we are interested in solving the minimization problem and common fixed point problem of a finite family consisting of total asymptotically non-expansive mappings in Hadamard spaces. For finding common solutions to their problems, we introduce a new modified proximal point algorithm with perturbation involving the convex combination technique. Under suitable conditions, Δ-convergence and strong convergence theorems are proved. Finally, we give some examples of numerical.

In this work, we present a solution to a major problem that most researchers meet, which is the solution of differential equations of different dimensions by presenting a new structure to n-dimensions for the Extended cubic B-spline collocation algorithm. The Extended cubic B-spline collocation forms are displayed in one, two and three dimensions. These constructs are of prime importance in solving mathematical models that have applications in various sciences. The efficiency and accuracy of these algorithms through a few test problems in two and three dimensions. Also, comparing our solutions and with the results obtained by using other numerical methods available in the literature as much as possible.

Decision tree (DT) is one of the most popular and efficient techniques in data mining. Specifically, in the clinical domain, DTs have been wildly used thanks to relatively easy interpretation and efficient computation time. However, some DT models may produce a large tree size structure which is difficult to understand and often leads to misclassification of data in the testing process. Therefore, a DT model which is a simple tree with high accuracy is the desired goal. Post pruning (PP) algorithms have been introduced to reduce the complexity of the tree structure with a minor decrease in the accuracy of classification. We propose a new Boolean satisfiability (SAT) based PP algorithm (Namely, SAT-PP algorithm) which reduces the tree size while preserving the accuracy of the unpruned tree, since in medical-related tasks, decreasing the model’s performance is something we emphatically try to avoid. Namely, in the case of medical-related tasks, one may prefer an unpruned DT model to a pruned DT model with worse performance. To evaluate the proposed algorithm and other PP algorithms, we compare the performance in terms of the model query response time and accuracy of classification using three oncology data sets. The SAT-PP DT model obtained the same accuracy and F1 score as the DT model without PP while significantly reducing computation time (6.8%).

To compare the performance of human papillomavirus (HPV)-based screening to cytology-based screening in the real-world programme in China. A cross-sectional study. Tongzhou district, Beijing, China. Women aged 35-64 years old underwent both cytology and high-risk HPV genotyping testing. The study assessed the real-world performance of four common screening strategies, including cytology with HPV testing triage (Strategy 1), HPV testing with cytology triage (Strategy 2), HPV testing with HPV-16/18 genotyping and reflex cytology for other high-risk HPV types (Strategy 3), and co-testing with HPV genotyping testing and cytology (Strategy 4). Sensitivity, specificity, and colposcopy referral rate. The study included 50,933 eligible women. HPV prevalence was 7.0% (95% confidential interval [CI]: 6.8%-7.2%), and cytology abnormal rate was 3.5% (3.3%-3.6%). Strategy 4 had the highest sensitivity for CIN3+ (90.6%, 95%CI: 84.5%-94.5%), followed by Strategy 3 (84.8%, 77.5%-90.1%), which were significantly higher than Strategy 1 (65.0%, 56.3%-72.8%). Strategy 2 had the equivalent sensitivity (59.2%, 50.5%-67.4%) compared with Strategy 1. The specificities slightly differed within four screening strategies ranging from 97.3% to 98.7%. The colposcopy referral rates in Strategy 4 (2.3%) and Strategy 3 (2.0%) were significantly higher than that in Strategy 2 (1.3%) and Strategy 1 (1.4%). Co-testing or HPV testing incorporating HPV-16/18 genotyping provided higher sensitivity, similar specificity, and a slight increase of colposcopy referrals compared with cytology-based screening in a large-scale cervical cancer screening programme, supporting the utilization of HPV-based screening in the real world. National Natural Science Foundation of China (grant no 81903328). Cervical cancer screening, performance, HPV, cytology.

A document by Mario Gil Castro. Click on the document to view its contents.

We faced a challenge to save the life of a patient with severe SARS-CoV2 infection. We applied different treatment strategies to cope with viral as well as opportunistic infections. Luckily, we were able to save the life of the patient and then we followed him up for more than 8 months. Patient had weakness, breathing problem along with psychiatric disturbance in post hospitalization period. Eight months later patient had vaccine for COVID-19 which showed a temporary side effects on him. This study can help front line health workers and clinician to save lives of the COVID-19 patients.

Aim The aim of the study was to define and compare persistence of infliximab and adalimumab according to the treatment line. The secondary objectives were to identify factors that influence persistence. Methods We performed an observational, retrospective, single-center study with adult patients diagnosed with Crohn’s disease between November 2001 and May 2020. A total of 309 patients were included. Survival analysis and Cox regression were used. The following factors were studied: gender, body mass index, use of concomitant immunosuppressants, time from diagnosis to the beginning of the biological, trough drug levels on target, year where the anti-TNFα began and initial patient characteristics at the beginning of the treatment. Results The median persistence associated with the first-line of anti-TNFα treatment showed a statistically significant difference with respect to the second-line (7.0 vs 5.2, p= 0.0082). Differences between infliximab and adalimumab were not statistically significant (7.8 vs 6.5, p= 0.91). The multivariate Cox analysis shows that only drug concentrations on target and year of initiation of anti-TNFα were associated with higher persistence in first-line treatment (p= 0.04). In the second-line the difference between the infliximab and adalimumab subgroups was not statistically significant (5.1 vs 5.2, p= 0.5). Only the year of initiation of treatment showed an influence on persistence. Conclusion Persistence was greater in the first-line. No differences in persistence were observed between infliximab and adalimumab. The most important influencing factors were the year of initiation of treatment and target drug concentrations.

At present, the number of people suffering from diabetes is increasing. Diabetes seriously threatens people’s life and health. Therefore, it is necessary to establish a predictive model of diabetes, assess the risk of diabetes and provide early warning of diabetes in time. This article focuses on machine learning combining with diabetes. Machine learning algorithms have good accuracy and generalization ability in dealing with complex problems. First, we analyze the risk factors of diabetes and divide the diabetes sample set into training set and test set. Second, the KNN (K-Nearest Neighbor) algorithm, decision tree algorithm, Gaussian Naive Bayes algorithm, and logistic regression linear algorithm are used to establish machine learning models. At last, experiments show that the decision tree classification prediction model achieves the highest accuracy 89.2%, which can better predict and analyze diabetes.

Objective: To explore ethnic minority women’s experiences of maternity care during the SARS-CoV-2 pandemic. Design: Qualitative study. Population: Sixteen Black, Asian and Minority Ethnic women who were pregnant, or had delivered within 6 weeks prior to interview in a predominantly urban Scottish health board area. Methods: Thematic analysis of semi-structured in-depth interviews. Results Four themes were identified: ‘communication’, ‘interactions with health care professionals’, ‘racism’ and ‘the pandemic effect’. Each theme had relevant sub-themes. ‘Communication’ encompassed respect, accent bias, language barrier and cultural dissonance; ‘interactions with health care professionals’: continuity of care, empathy, informed decision making and dissonance with other health care systems; ‘racism’ was deemed to be institutional, interpersonal and internalised; and ‘the pandemic effect’ consisted of isolation, psychological impact and barriers to access of care. Main outcome measures: To explore the experiences of pregnancy, childbirth, antenatal and postnatal care in women belonging to ethnic minorities and to identify any specific challenges that these women faced during the SARS-CoV-2 pandemic. Conclusions This study highlights specific challenges faced by ethnic minority women in pregnancy, which intersect with the unique problems posed by the ongoing SARS-CoV-2 pandemic to potentially widen existing ethnic disparities in experiences of maternity care. Funding: Ethical approval for this study was granted by the Research Ethics Committee of West of Scotland (20/WS/0168) on 26/11/2020.

This scoping review explored the impact of disasters on contraception in high-income countries. Comprehensive searches were conducted and extracted data analysed thematically. 110 articles were included. The majority focused on the Zika virus outbreak and the COVID-19 pandemic. Four key themes were identified: importance of contraception during disasters, impact of disasters on contraceptive behaviour, barriers to contraception during disasters and ways of improving uptake of contraception during disasters. Despite efforts to increase access to contraception, barriers to uptake meant unmet need persisted. To prevent adverse health outcomes and reduce health costs, efforts to remove barriers to uptake should be intensified.

Jubaea chilensis (Molina)Baill., also named Chilean palm, is an endemic species found in the coastal area of Mediterranean sclerophyllous forest in Chile. It has a highly restricted and fragmented distribution along the coast, being under intense exploitation and anthropogenic impact. Based on 1,038 SNP markers, we evaluated the genetic diversity and population structure among six J. chilensis natural groups. We observed low levels of genetic diversity (overall HE = 0.024 and HO =0.014), a deficit of heterozygotes, and high levels of inbreeding (mean FIS = 0.424), with little or no random mating. All Wright fixation index and Nei’s genetic distance pairwise comparisons indicated moderate differentiation among populations, with a tendency to similarity. There was no evidence of isolation by distance (r =-0.214, P =0.799). In the cluster analysis, we observed a closer relationship among Culimo, Cocalán and Candelaria populations. The K value that best represented the spatial distribution of genetic diversity was ∆K =3. Habitat fragmentation and deterioration of the sclerophyllous forest may have driven inbreeding and low levels of genetic diversity in the palm groves of J. chilensis, putting the persistence of present and future populations at risk. In this scenario, it is imperative to reclassify J. chilensis as an endangered species, as well as a Natural Monument, in order to improve conservation efforts, the species management, and the environmental protection Also, the preservation of genetically different individuals may increase the overall genetic variability required to sustain the species persistence in the context of climate change and anthropogenic disturbance.

This study examined the prevalence and predictors of burnout syndrome early in the medical career. This cross-sectional study was conducted among a random sample of medical interns enrolled in the Omani internship program, in 2019. There were 180 interns participating in this study, and they filled in a self-reported questionnaire that included Maslach Burnout Inventory (MBI) and job satisfaction survey (JSS). The response rate was 71%. The prevalence of burnout and job dissatisfaction were 15% and 22%, respectively. Individual burnout subscale results were 33.3% for emotional exhaustion (EE), 37.2% for depersonalization (DP) and 65.5% for low personal accomplishment (PA). High levels of emotional exhaustion subscale were noted to be correlated with living alone (odds ratio [OR] = 3.903, 95% confidence interval [CI] = 1.150-13.241), the institute of graduation (National University of Science and Technology graduates: OR = 4.515, 95% CI = 1.537-13.265; graduating abroad: OR = 5.494, 95% CI = 1.343-22.475, P = 0.018), having a physical illness (OR = 7.285, 95% CI = 1.976-26.857) and being dissatisfied (OR = 16.488, 95% CI = 5.371-50.614). Variables leading to high levels of depersonalization were the institute of graduation (graduating abroad; OR = 0.239, 95% CI = 0.060-0.946), having a physical illness (OR = 4.678, 95% CI = 1.498-14.608) and being dissatisfied (OR = 2.900, 95% CI = 11.159-7.257; P = 0.023). Low personal accomplishment was only predicted by having a physical illness (OR = 0.258, 95% CI = 0.088-0.759). Job dissatisfaction was found to elevate the risk of occupational burnout.