Introduction: Previous Indian studies have depicted disparities in the uptake of cesarean sections (CS) across states and health sectors using household survey data. However, granular multi-year analyses are missing. In this India-wide retrospective analysis using data from India’s Health Management Information System (HMIS), population-level CS rates, annual percent changes, and public-private differences across different geographic levels were estimated.Methods: HMIS count data were obtained for total, public, and private CS surgeries across 737 districts in 37 states for the nine financial years (2011-2019) from the National Data and Analytics Platform. Annual CS rates were defined as the number of CS surgeries per 100 live births reported. Unweighted average annual percent changes were computed for CS rates. The excess CS rate was defined as the WHO threshold of 10% CS per 100 live births. District-level data were aggregated for estimating state and national rates. Public-private CS rate comparisons were conducted using paired Wilcox tests.  Results: In 2019, total, public, and private CS rates were 19.56%, 14.20%, and 34.47%, respectively. The average annual changes were 8%, 5.83%, and 5.86% for total, public, and private-sector CS rates, respectively. In 2019, 32 of the 37 states crossed the excess threshold for total CS rates. In 2019, CS rates varied across districts. Of the 737 districts, 331 had excess CS surgeries. Private facilities in 530 districts had higher CS rates than public facilities in 390 districts. Zero CS uptake was observed in 24 districts, mostly in northeastern states. Most districts with excess sections were clustered in the southern states of Telangana, Tamil Nadu, and Kerala. The district-level comparison showed significantly higher CS rates in private than in public-sector facilities.  Conclusion: Excess cesarean sections in India are driven largely by the private sector in districts clustered in south and central India, while several states in North and Northeast India lack CS delivery capacity in public facilities. To ensure quality care, India needs a targeted policy approach that regulates the private sector and simultaneously strengthens the public system.

OBJECTIVE: This wellness program sought to identify the prevalence of burnout in a pediatric hematology/oncology/blood and marrow transplantation (BMT) center and to tailor workplace wellness initiatives to support staff. METHODS: Providers and staff from a pediatric hematology/oncology/BMT center were invited to complete an anonymous survey that included items from the Maslach Burnout Inventory for Medical Personnel (MBI-MP) and author-developed questions to assess burnout and helpfulness of program initiatives. Analyses included descriptive and inferential statistics. RESULTS: Just over half of respondents endorsed high risk of burnout. Advanced Practice Providers (APPs), Registered Nurses (RN)/Care Partners (CP), and the Oncology and Multiple specialties (individuals serving multiple specialties [i.e., oncology and BMT]) had the largest proportions of individuals at high risk of burnout. Inpatient nurses and those who have worked in the division for 1-5 years endorsed greater risk of burnout compared to their counterparts. Most respondents reported all initiatives were somewhat to very helpful, with initiatives aimed at bereavement support rated as most helpful. CONCLUSIONS: Our wellness program continues to refine the initiatives offered to align with our purpose of increasing engagement, reducing burnout, and improving staff retention. While the benefits of programming targeting individual level drivers of burnout should be highlighted, the critical state of burnout requires leadership support and engagement in wellness efforts to advance wellness culture in the medical field beyond the limits of individual level interventions alone.

Introduction: Human respiratory syncytial virus (RSV) is one of the most frequent causes of respiratory infections in children under five years of age, but its socio-economic impact and burden in primary care settings is still little studied. Methods: During the 2022/23 winter season, 55 pediatricians from five Italian regions participated in our community-based study. They collected a nasal swab for RSV molecular test from 650 patients under the age of 5 with Acute Respiratory Infections (ARIs) and performed a baseline questionnaire. The clinical and socio-economic burden of RSV disease in primary care was evaluated by two follow-up questionnaires completed by the parents of positive children, on day 14 and 30. Results: RSV laboratory-confirmed cases were 37.8% of the total recruited ARI cases, with RSV subtype B accounting for the majority (65.4%) of RSV-positive swabs. RSV-positive children were younger than RSV-negative ones (median 12.5 vs 16.5 months). The mean duration of symptoms for all children infected by RSV was 11.47 ± 6.27 days. We did not observe substantial differences in clinical severity between the two RSV subtypes, but RSV-A positive patients required more additional pediatric examinations than RSV-B cases. The socioeconomic impact of RSV infection was considerable, causing 53% of children to be absent from school, 46% of parents to lose working days and 25% of families to incur extra costs. Conclusions: Our findings describe a baseline of the RSV disease burden in primary care in Italy before the introduction of upcoming immunization strategies.

Abstract Ticks are notorious blood-sucking ectoparasites affecting both humans and animals, and serve as a unique vector of various deadly diseases. Here, we have shown the roles of the receptor for advanced glycation end-products (RAGE) during repeated infestations by the tick, Haemaphysalis longicornis using RAGE-/- mice. In primary infestation, a large blood pool developed which was flooded with numerous RBC, especially during the rapid feeding phase of the tick both in wild type (wt) and RAGE-/- mice. Very few inflammatory cells were detected around the zones of hemorrhage in the primary infestations. However, number of inflammatory cells gradually increased in the subsequent tick infestations and at the 3 rd infestations number of inflammatory cells reached to the highest level (350.3±16.8 cells/focus), and the site of attachment was totally occupied by the inflammatory cells in wild type (wt) mice whereas very few cells were detected at the ticks’ biting sites in RAGE-/- mice. RAGE was highly expressed in the 3 rd infestation in wt mice. In the 3 rd infestation, infiltration of innate lymphoid cells type 2 (ILC2s), expression of S100A8 and S100B significantly increased at the biting sites of ticks in wt, but not in RAGE -/- mice. Also, peripheral eosinophil counts significantly increased in wt but not in RAGE -/- mice. Taken together, our study revealed that RAGE-mediated inflammation and eosinophils played crucial roles in the tick induced inflammatory reactions.

The olfactory sense is crucial for organisms, facilitating environmental recognition and inter-individual communication. Ithomiini butterflies exemplify this importance not only because they rely strongly on olfactory cues in both inter- and intra-sexual behaviours, but also because they show re-emergence of macro-glomerular complexes (MGCs). These specialized structures within the antennal lobe, lost in butterflies, but present in moths where they enable the integration of information from various types of pheromones, refining responses to specific cues. In this study we present high-quality genome assemblies for four Ithomiini species, investigating chemosensory evolution and associating expression profiles with neuroanatomical differences. We found that antennal transcriptomes across species exhibit profound divergence, indicating distinct species adaptations in environmental sensing. Noteworthy, sexual dimorphism is also characterised both in chemosensory genes and non-chemosensory genes, suggesting their relevance in behaviour. Lipid-related genes exhibit sexual dimorphism, potentially linked to pheromone production or host selection. The study broadens the understanding of antennal chemosensory adaptations in butterflies, highlighting the intricate interplay between genetic diversity, ecological specialization, and sensory perception with neuro-anatomical differences. Insights into chemosensory gene evolution, expression patterns, and potential functional implications enhance our knowledge of sensory adaptations in butterflies, laying the foundation for future investigations into the genetic drivers of behaviour, adaptation, and speciation in insects.

A document by Xing Cai. Click on the document to view its contents.

This study addresses the lack of information about bleeding incidences, location and risk factors in children admitted to hospital. The primary objective of this study was to determine the incidence of bleeding in children admitted to hospital. Methods: In a retrospective observational cohort study, the first admittance of 13,842 children (<18 years old) to Odense University Hospital from 2015-2020 was analyzed. Bleeding episodes and the anatomical location of bleeding were identified in electronic health record (EHR) text using a combination of artificial intelligence and manual validation. The study determined cumulative bleeding incidence during admission with Kaplan-Meier analysis and the anatomical locations of bleedings in frequencies and numbers. Subgroup analyses included spontaneous and major bleeding, and bleeding during intensive care unit (ICU) stay. Results: Overall, 1869 children bled at admission and 1523 during admission. The most frequent locations of bleeding were cutaneous, internal, and gastrointestinal, comprising 70% of episodes. The cumulative incidence of bleeding during admission was 29.1% and 19.0% for any bleeding and spontaneous bleeding, respectively. Spontaneous and major bleeding occurred in 794 (6.6%) and 174 (1.5%) of children, and six bleedings contributed to death (all central nervous system bleeds). Bleedings occurred in 36% admissions complicated with ICU stay. Independent risk factors for bleeding were prematurity, hematological cancer, infection, congenital anomalies, anticoagulants, administration and ICU stay. Conclusions: The study found a high incidence of bleeding in admitted children, and fatal bleeding episodes were registered. Thus, bleeding risk shall be considered during admission of children.

Editorial Comment on “Atopic outcomes at 2 years in the CORAL cohort, born in COVID-19 lockdown”Sandoval-Ruballos, Mónica1, Carmen Riggioni2,3, Jon Genuneit41 Pediatric Allergy and Immunology Clinic, Guatemala, Guatemala.2Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.3Khoo Teck Puat-National University Children’s Medical Institute, National University Hospital, National University Health System, Singapore.4 Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, GermanyAtopic conditions have been on the rise globally, particularly in industrialized nations.(1) This phenomenon has spurred interest in the potential connection between the surge in allergic disorders and modern lifestyles characterized by reduced microbial exposure and increased hygiene practices. While the hygiene theory proposes that the early childhood microbial environment plays a pivotal role in shaping immune system development, reducing the risk of atopic conditions, more recent findings have emphasized the role of a defective epithelial barrier. This recent perspective suggests that the upsurge in agents damaging the epithelial barrier, associated with industrialization and modern living, is at the core of the escalation of allergic, autoimmune, and other chronic conditions. Notably, these effects may have intensified during the pandemic. (2) (3)The SARS-CoV-2 pandemic in early 2020 prompted various lockdowns and stringent hygiene measures, offering an intriguing opportunity to investigate the impact of these altered environmental factors on the prevalence of atopic conditions. The CORAL study is a longitudinal observational project, following 365 infants born in Ireland, during the initial pandemic period (March-May 2020) from enrollment to 24 months of age. (4) The authors compared the occurrence of allergic diseases with a pre-pandemic Irish cohort (BASELINE study 2008-2011). (5) This investigation aims to shed light on the pandemic’s potential impact on infant allergic disease development.At first glance, the CORAL cohort exhibited higher rates of atopic dermatitis (AD) at both 12 and 24 months compared to BASELINE. However, this finding may reflect a gradual increase in AD incidence within their population, given that the BASELINE cohort was born about one decade earlier. Alternatively, the early-life environment during the lockdowns may have played a role. In addition, the authors delineated three patterns of AD. A more severe AD phenotype was noted among infants with persistent AD diagnosis at 24 months, and AD-persistent infants were more likely to be sensitized. This observation aligns with prior studies, highlighting the significance of severity, and atopic sensitization as relevant determinants of AD prognosis.(6)While AD rates were higher in the CORAL cohort, they exhibited lower rates of food sensitization and allergy compared to BASELINE, particularly significant in peanut sensitization and egg allergy, with a non-significant trend towards lower peanut allergy. Importantly, parents received complementary feeding advice at 6 months, emphasizing early peanut introduction. Therefore, these outcomes may be attributed to recommended early allergen introduction, along with other factors like increased breastfeeding, fewer infections during the first 12 months (7), lower antibiotic exposure, and sustained dietary allergen exposure during lockdown. The relevance of early allergen introduction, especially for peanut and egg, has gained prominence in international guidelines more recently, owing to accumulating evidence underscoring its role in directly reducing the development of food allergy (8).At 24 months, antibiotic usage and childcare outside home increased AD likelihood potentially linked to decreased infection rates and antibiotic use in children not attending daycare, preserving microbiota integrity. Intriguingly, despite more AD cases in children attending daycare, they exhibited lower allergic sensitization rates. Aeroallergen sensitization at 24 months was more pronounced among children cared for solely at home, thus reflecting environmental influence. From a theoretical perspective, it is plausible that the lockdown measures, which led to a substantial increase in indoor confinement, may have resulted in heightened exposure to indoor allergens,(9) consequently leading to higher sensitization rates. Furthermore, allergic sensitization at 12 and 24 months was associated with AD at both time points and with asthma diagnosis at 24 months.Despite its valuable insights, the CORAL study has limitations, including a small cohort size and potential selection bias, as it represented only 12% of eligible children. Here, high breastfeeding rates and low parental smoking rates may limit generalizability. Additionally, the small sample size might hinder the identification of associations that might be evident in larger cohorts.Other studies conducted during the pandemic have primarily focused on assessing the impact on allergic conditions during lockdowns. They have often reported positive effects of interventions such as hygiene, mask usage, and social distancing in reducing air pollution and lowering infection rates, potentially resulting in a reduced impact on allergic conditions (10). The CORAL study stands out among these studies due to its specific objective of evaluating the effect of lockdowns on the incidence of allergic diseases. Finally, it provides valuable insights into how the pandemic have influenced the health of infants born during this period. While the increased incidence of AD initially raises concerns, the lower rates of food sensitization and allergies suggest the positive effects of evolving allergy practices, particularly early allergen introduction. Furthermore, the beneficial impacts of lockdown, such as increased breastfeeding and reduced antibiotic use, may outweigh the anticipated risks associated with reduced early-life microbial exposures.This study enhances our understanding of the real-world impact of early-life environments on allergic disease risk. Continuous monitoring of the CORAL cohort into later childhood will reveal the lasting consequences of being born during the pandemic. These findings underscore the intricate interplay between environmental factors, infant health, and the development of allergies in a rapidly evolving landscape of healthcare practices.

Wolves and other wildlife species that share habitats with humans with minor options for spatial avoidance must either tolerate frequent human encounters, which may be lethal, or allocate their activity to those periods of the day when the risk of encountering humans is smallest and the consequences least severe. This may force wolves in densely human-populated and cultivated landscapes to either become highly nocturnally active or habituate to human stimuli. Based on 6,220 camera trap images of adult wolves from eight territories in Denmark, we analyzed the extent to which diel activity patterns in a wolf population in a highly cultivated landscape with fragmented forests and extensive public access could be explained from diel variation in darkness, human activity, and prey (deer) activity. We found that diel activity correlated with all three factors simultaneously with human activity (negative) having the strongest total as well as partial effect, followed by darkness (positive) and deer activity (positive). Relative to a model that smoothed activity as a function of time of the day, the three factors accounted for 94% of the explainable diel variation in wolf activity. As most of the apparent selection for darkness could be explained by temporal human avoidance, we suggest that nocturnality (proportion of observations registered at night vs. day at equinox) is a useful proxy for investment in temporal human avoidance. In this study, wolf packs were 7.0 (95% CI: 5.0-9.7) times more active at night than at daytime, which makes Danish wolves amongst the most nocturnally active wolves reported so far. This result confirms the initial prediction that wolves with few options for spatial avoidance, invest heavily in temporal human avoidance.

The current crisis of global climate change and its consequences which are manifested in form of different environmental disasters is attributed to excessive emission and accumulation of greenhouse gases in the atmosphere, key among which is carbon dioxide. Hence, remedies are needed to mitigate against this change in climate. A mathematical model on climate change incorporating good conservation policies, enlightenment programmes and direct air capture technology as mitigation measures is formulated and analysed using the concept of optimal control theory and cost-effectiveness analysis. The objective functional is set up to minimize both the excessive concentration of carbon dioxide in the atmosphere and the total cost of implementation of each mitigation measure, as the resources available to cater for the needs of the teeming human population are limited. By formulating a Hamiltonian function and using Pontryagin’s Principle, the adjoint equations and characterisation of the optimal units were calculated. Using the optimality control system obtained, the numerical simulation was done in MATLAB using the Forward Backward Sweep algorithm of the Runge-Kutta Method. Seven different strategies of mitigation scenarios were simulated. From the results, each of these strategies has the potency to reduce the excessive concentration of carbon dioxide in the atmosphere. However, the best result was obtained using the strategy that combines all the three mitigation measures of good conservation policies, enlightenment programmes and direct air capture technology. Despite that this strategy (Strategy VII) appears the most desirable option to adopt, the cost of implementation of each strategy has to be considered since human resources are limited. Therefore, cost-effectiveness analysis techniques (Average Cost-Effectiveness Ratio and Incremental Cost-Effectiveness Ratio ) were used to arrive at the most cost-friendly strategy. From the computations involving these two ratios, both indicated good conservation policies strategy as the cheapest option to adopt in reducing the excessive concentration of carbon dioxide in the atmosphere.

Hydatid disease is an infectious disease caused by echinococcus granulosus which mainly caused liver and lungs damaged in humans. Bone involvement is rare and accounts for only 0.5%-4% in hydatid disease, spine is more prone to be infected with a proportion of 50% in musculoskeletal tissue. We present a case of spinal hydatidosis in a 47‑year‑old male presenting with low back pain radiating to the legs, progressive weakness and hypaesthesia in the lower limbs accompanied with difficulty walking. Computed tomography (CT) images showed a spinal hydatid cyst in lumbar vertebra2 and caused bone destruction of the vertebral body and lamina. Magnetic resonance imaging (MRI) images showed hyperintense cystic components on lumbar vertebra2 with the appearance of a lobulated, multiocular, septated cystic mass and compressing of the spinal cord at segments lumbar vertebra1-2. The patient underwent subtotal vertebral resection to completely remove the damaged vertebral and paravertebral cysts, and histopathological examination showed the characteristic features of hydatid cysts. The patient received antiparasitic drugs treatment post-operation. The surgical removement combined with antiviral drugs is an effective way to treat spinal hydatidosis.

1. The gut microbiota of rodents is essential for survival and adaptation, and has been shown to be susceptible to a variety of factors, ranging from environmental conditions to genetic predispositions. Nevertheless, few comparative studies have considered the contribution of species identity and geographic spatial distance to the variation in gut microbiota. 2. Here, we investigated the gut microbial communities of four wild rodent species (Rattus norvegicus, Apodemus agrarius, Cricetulus barabensis, and Tscherskia triton) at five sites in northern China’s farming-pastoral transition zone. By performing a cross-factorial comparison, we are able to test whether belonging to the same species, or instead, being in the same capture site dominates in determining gut microbiota composition. 3. Our analysis found that the Amplicon Sequence Variants (ASVs) showed a partial overlap with the species identity and the geographic capture sites, which did not reveal a ‘phylosymbiosis’ pattern. 4. The gut microbiota of these four rodent species adhered to typical mammalian characteristics, predominantly characterised by the Firmicutes and Bacteroidetes phyla. As the geographic distance between populations increased, the shared microbial taxa among conspecific populations decreased. We observed that within a relatively small geographical range, even different species exhibit convergent α-diversity due to their inhabitation within the same environmental microbial pool. In contrast, the composition and structure of the intestinal microbiota in allopatric populations of A. agrarius showed marked differences, as well as C. barabensis. Additionally, geographical environmental elements, exhibited significant correlations with diversity indices. Conversely, host-related factors had minimal influence on microbial abundance. 5. These findings illuminated that the similarity of the microbial compositions was not determined primarily by the host species, the location of the sampling explained a greater amount of variation in the microbial composition, indicating that the local environment played a crucial role in shaping the microbial composition.

More than 30% of extant shark species are classified as threatened with extinction, yet reliable population-level data is often rare, frequently due to a lack of genomic resources. Here we present a new genome-wide marker set for endangered shark species. We developed a target gene capture bait set based on the transcriptome and genome of a Lamnid shark, and tested it on 36 shark specimens, representing seven species from three orders. Illumina read mapping and calling of Single Nucleotide Polymorphisms (SNPs) showed high target recovery rates, especially in the order Lamniformes, providing several thousand detected biallelic SNPs in each species tested. Our results show this marker set can be used for SNP-calling in a broad range of shark species, enabling detailed population assessments and other ecological and evolutionary studies.

Currently, there is much interest in the study on the localized waves and their interactions in fluid mechanics. An extended (3+1)-dimensional Kadomtsev-Petviashvili equation in fluid mechanics is considered here. By means of the Hirota method, we obtain the N-soliton solutions, with N as a positive integer. The higher-order breather solutions are obtained from the N-soliton solutions employing the complex conjugated transformations. Making use of the long-wave limit method, we determine the higher-order lump solutions from the N-soliton solutions. Besides, some hybrid solutions are presented. Three kind of the localized waves, namely, the solitons, breathers and lumps, along with their interactions, are investigated via the above solutions. Amplitudes, shapes and velocities of those localized waves remain invariant after the interactions, which indicates the interactions are elastic.

1. Using the Farapulse pulse configuration and ablation procedure results in a significant esophageal temperature increase that is underestimated using the Circa probe and it is likely significantly higher temperature can be recorded at close proximity to the ablation electrodes. 2. A near-field tissue ablation is a mix of irreversible electroporation and thermal injury. 3. The bipolar energy delivery using the Farawave-catheter limits the field and thermal ablation to close proximity to the bipolar ablation electrodes limiting the impact on extracardiac tissues. 4. In the two published papers accompanying this editorial, the Farapulse PFA technology is shown to have no short or long-term adverse effect on the esophagus. However, reported phrenic nerve conduction stunning may occur (7,8). It is also noted that while Meininghaus et al. reported significant esophageal acute injuries using RF and Cryo no long-term data is provided that these findings resulted in long-term disabilities. 5. PFA is hampered by the inability to adequately assess irreversible lesion formation in real-time. 6. The advantage provided by using PFA ablation technology is added safety and faster procedure time. These conclusions need further affirmation when the technology is widely used.

A 3D-printed X-band evanescent mode waveguide filter based on pixelization strategy is proposed in this letter. The uniqueness of the filter lies in the exploitation of the evanescent mode waveguide in conjunction with a 3D-printed dielectric pixelated structure. The crucial advantage of this approach is the fact that the dielectric pixelated structure located in a waveguide is not metal coated, so the fabrication process is easier. The proposed filter is manufactured using the fused deposition modeling 3D print technology. Its measured transmission coefficient in the passband is approximately -2 dB, and the reflection coefficient is below -19 dB.

Objective: This study investigated the efficacy of the prophylactic human papillomavirus (HPV) vaccine started at 2009- 2013 in Japan. Materials and Methods: The study involved 1529 eligible women aged 16 to 39 years who visited 11 outpatient clinics for various reasons in Japan. All these patients underwent an examination of HPV genotype and a Pap test using cervical cell samples. Two hundred ninty-nine women (19.6%) received the prophylactic HPV vaccine (bivalent :quadrivalent vaccine ratio = 2:1). Of the 5062 participants in the Japanese Human Papillomavirus Disease Education and Research Survey (J-HERS 2011), which was conducted in the pre-vaccination era, 3236 eligible participants were included as controls. Results: In the present study (J-HERS 2021), highest rate for HPV vaccination (53%) was observed in 22- to 27-year-old patients. Vaccinated ones showed 49% protection against low-grade intraepithelial lesions (LSIL) and atypical squamous cells not excluding high-grade squamous intraepithelial lesions (ASCH) or worse (LSIL/ASCH+), and 100% protection against high-grade squamous intraepithelial lesions (HSIL) or worse (HSIL+). The prevalences of HPV16 and HPV18 infections also significantly decreased (HPV16; 95% and HPV18; 100%), but there were no differences in HPV6 and HPV11 infections by the vaccination. The prevalences of HPV51 and HPV59 increased with vaccination, although these changes were not confirmed in the comparative study with J-HERS 2011. Comparisons between the pre-vaccination period (J-HERS 2011) and post-vaccination period (J-HERS 2021) revealed reduction rates of 43%, 51%, 88%, and 62% were observed for HPV16, HPV18, HPV16/18, and HPV31/58 infections, respectively. Similarly, reduction rates of 62% and 71% for LSIL/ASCH+ and HSIL+, respectively. The reduction rate for LSIL/ASCH+ was 88% in 16- to 21-year-old patients, whereas the rate for HSIL+ was 87% in 28- to 33-year-old patients. C onclusion: Bivalent or quadrivalent vaccines provided 100% protection against high-grade squamous cell lesions (suggestive of CIN2 or CIN3) in young women aged < 39 years at 9 to 12 years after initiation of the first nationwide HPV vaccination program in Japan. Cross-protection against HPV31 and HPV58 is likely to occur, although some HPV type replacements are inconsistent across vaccination regimens. This demonstrates a high effectiveness of HPV vaccine. In contrast, we worry about no reduction of cervical cancer in younger generation (born in 1997-2007) who are rarely vaccinated due to long term suspension of this vaccine recommendation in Japan.

Trichloroacetic acid (TCA) is well known in recent decades mostly through its application in cosmetology as a chemical peeling agent. However, it has been also used for chemosurgery across various medical specialties. TCA was first introduced to the local treatment of airborne allergies and rhinorrhea in the late 1980s and has since then widely studied, mostly in Japan, the Middle East, and Brazil. Numerous reports suggest that the nasal application may be effective and safe even in high concentrations. In this review, we are discussing the topical TCA application for local treatment and prevention of allergic rhinitis, a management option that is not well known in Europe and the Western hemisphere. We believe that TCA fits the ideal category for medication, being inexpensive, readily available, easy-to-use, and safe. We postulate its potential efficacy and urge consideration of new clinical trials. Local delivery of TCA in the form of contact application directly to the nasal cavity has a preventive effect neutralizing allergen entry points by blocking receptor cells and have therapeutic benefit for those in whom conventional therapies are ineffective or unpractical, and especially in areas or limited medical and financial resources.

Numerous strategies have been explored to address environmental concerns stemming from heat-absorbing materials in the construction industry. One promising approach involves optimizing building materials for high reflectivity of incoming sunlight and enhanced thermal emissivity within atmospheric windows. Given that these radiative properties are closely linked to surface morphology characteristics, the superficial topography of building materials emerges as a critical factor in shaping their thermal and energy performance. To investigate this, an experimental and statistical study has been conducted to evaluate how surface components impact the radiative properties of building materials. Findings underscore the significant role of surface morphology as a secondary influence on radiative properties. Specifically, has been observed that large-scale components affect Mid-Infrared (MIR) absorbance, while surface roughness plays a key role in solar reflectance properties. Notably, increasing roughness consistently reduces Near-Infrared (NIR) and visible reflectance properties, by up to 17% and 8%, respectively, with no discernible impact in the UV region. In summary, this research demonstrates the feasibility of tailoring and optimizing surface properties to diminish energy consumption for cooling purposes and to mitigate the Urban Heat Island (UHI) effect.

Following the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) treatment algorithm for chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP), patients suffering from severe uncontrolled CRSwNP are recommended to receive oral corticosteroids, (revision) sinus surgery, systemic biologicals, and/or aspirin treatment after desensitization (ATAD). Given the major differences in indications, outcomes, practical considerations, risks and costs of these key pillars of treatment, there is a growing need to define criteria for each treatment option and list the clinically relevant and major considerations for them. This EUFOREA document therefore provides an expert panel overview of the expected outcomes, specific considerations and (contra)indications of the five major treatment arms of severe uncontrolled CRSwNP: oral corticosteroids, primary and revision sinus surgery, biological treatment, and ATAD. This overview of treatment considerations is needed to allow physicians and patients to consider the different options in the context of providing optimal and personalized care for severe uncontrolled CRSwNP. In conclusion, the five major treatment options for severe uncontrolled CRSwNP have intrinsic advantages, specific indications, and considerations that are of importance to the patient, the physician, and the society. This EUFOREA statement supports the unmet need to define criteria for the indication of every treatment pillar of CRSwNP.

Individuals diagnosed with schizophrenia (SZ) demonstrate difficulty distinguishing between internally- and externally-generated stimuli. These aberrations in “source monitoring” have been theorized as contributing to symptoms of the disorder, including hallucinations and delusions. Altered connectivity within the default mode network (DMN) of the brain has been proposed as a mechanism through which discrimination between self-generated and externally-generated events is disrupted. Source monitoring abnormalities in SZ have additionally been linked to impairments in selective attention and inhibitory processing, which are reliably observed via the N100 component of the event-related brain potential elicited during an auditory paired-stimulus paradigm. Given overlapping constructs associated with DMN connectivity and N100 in SZ, the present investigation evaluated relationships between these measures of disorder-related dysfunction and sought to clarify the nature of task-based DMN function in SZ. DMN connectivity and N100 measures were assessed using EEG recorded from SZ after their first episode of illness (N = 52) and demographically-matched healthy comparison participants (N= 25). SZ demonstrated less evoked theta-band connectivity within DMN following presentation of pairs of identical auditory stimuli than HC. Greater DMN connectivity among SZ was associated with better performance on measures of sustained attention (p = 0.03) and working memory (p = 0.09), as well as lower severity of negative symptoms, though it was not predictive of N100 measures. Together, present findings provide EEG evidence of lower task-based connectivity among first-episode SZ, reflecting disruptions of DMN functions that support cognitive processes. Attentional processes captured by N100 appear to be supported by different neural mechanisms.

Introduction: Pseudomonas aeruginosa AUST-03 (ST242) has been reported to cause epidemics in cystic fibrosis (CF) patients from Tasmania and Australia and has been associated with multidrug resistance and increased morbidity and mortality. Here, we report epidemic P. aeruginosa (AUST-03) strains in South African CF patients at a public academic hospital detected during a previous study and characterise the resistomes. Methods: The P. aeruginosa AUST-03 (ST242) strains were analysed with whole genome sequencing using the Illumina NextSeq2000 platform. Raw sequencing reads were processed using the Jekesa pipeline and multi-locus sequence typing and resistome characterisation was performed using public databases. Core single nucleotide polymorphism phylogenies were performed on P. aeruginosa ST242 strains from the study and from public databases. Antibiotic susceptibility testing was performed using the disk diffusion and broth microdilution techniques. Results: A total of 11 P. aeruginosa AUST-03 strains were isolated from two children with CF who had pulmonary exacerbations. The majority of the P. aeruginosa AUST-03 strains (8/11) were multidrug resistant (MDR) or extensively drug resistant; and the multidrug efflux pumps MexAB-OprM, MexCD-OprJ, MexEF-OprN, MexXY-OprM were the most clinically relevant antibiotic resistance determinants and were detected in all of the strains. The P. aeruginosa AUST-03 (ST242) study strains were most closely related to strains from Canada, China, Denmark and Slovenia. Conclusion: Epidemic MDR P. aeruginosa strains are present at South African public CF clinics and need to be considered when implementing patient segregation and infection control strategies to prevent further spread and outbreaks.

Late Development of Pneumatoceles in Necrotizing PneumoniaSila Y. Kocer 1, Nathan C. Hull MD2, D. Dean Potter, Jr. MD 3, Theresa Madigan MD 4, Jennifer M. Boland MD5 and Nadir Demirel MD 61Ondokuz Mayis University School of Medicine, Samsun, Turkey2Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA. Email address: hull.nathan@mayo.edu3Division of Pediatric Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA. Email address: potter.d@mayo.edu4Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA. Email address: madigan.theresa@mayo.edu5Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA. Email address: boland.jennifer@mayo.edu6Division of Pediatric Pulmonology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA. Email address: demirel.nadir@mayo.eduCorrespondence : Sila Y. Kocer, Ondokuz Mayis University School of Medicine, Körfez, 55270 Samsun, Turkey. Email address: silayagmurkocer1@gmail.com. Tel.: +905514571963Conflict of interest: The authors declare no conflict of interest.Author contributions : Sila Y. Kocer: Writing – original draft. Nathan C. Hull: Writing – review and editing.D. Dean Potter Jr.: Writing – review and editing.Theresa Madigan: Writing – review and editing.Jennifer M. Boland: Writing – review and editing.Nadir Demirel: Writing – review and editing.Keywords : Lung cysts; complicated pneumonia; lobectomy; imaging; childrenTo the editor,Community-acquired pneumonia (CAP) is one of the most common serious infections in children, although it usually has a good prognosis1. Necrotizing pneumonia (NP), a rare but severe complication of CAP, consists of the destruction of the consolidated lung parenchyma, potentially leading to the formation of thin-walled cavities known as pneumatoceles 2. While they often resolve spontaneously without sequalae, progressively enlarging pneumatoceles have been reported 5. We report a pediatric case with an unusual course of pneumatocele development.A 3-year-old female with history of congenital hypothyroidism and mild asthma presented to her primary care physician for evaluation of intermittent fever for the past 6 days, with a maximum temperature of 38.8°C. She had a worsening wet cough and complained of chest pain while coughing. Lung examination was normal except for mild tachypnea. Based on the patient’s presentation, empiric oral amoxicillin 90 mg/kg/day was started for possible CAP. The patient presented to the clinic on day 6 of her antibiotic treatment with persistent low-grade fever and ongoing cough. She had normal vital signs, and there were no signs of respiratory distress. The lung examination revealed crackles at right lung fields. A chest X-ray (CXR) showed a large consolidation and an airspace with an air-fluid level in the right upper lobe (RUL) (Figure 1A). There was no pleural effusion. The patient was diagnosed with complicated pneumonia and was referred to our hospital.A chest computed tomography (CT) without intravenous (IV) contrast showed a large consolidation in the RUL with scattered internal cystic areas containing air-fluid levels (Figure 1B, C). These findings raised concern for NP, abscess, or congenital pulmonary airway malformation with superimposed pneumonia. Laboratory test results showed mild anemia (hemoglobin concentration of 10 g/dl), leukocytosis (white blood cell count of 14.1 x 109/L), thrombocytosis (platelet count of 752 x 109/L), and high C-reactive protein (CRP) (80 mg/L, normal: <5 mg/L). She was admitted and started on IV ceftriaxone and IV vancomycin. She remained afebrile during admission and was clinically well appearing. A nasal swab culture for Methicillin-resistant Staphylococcus aureus was negative, therefore, on day 2 of admission, IV vancomycin was discontinued. AStreptococcus pneumoniae urine antigen test was positive. Serologic testing for endemic fungi was negative. A QuantiFERON-TB Gold was indeterminate due to inadequate mitogen response. On day 3 of admission, in preparation for discharge, IV ceftriaxone was switched to oral cefdinir 14 mg/kg/day to complete a 4-week course. She remained afebrile and well after an additional 24-hour period of observation and was subsequently discharged.Towards the conclusion of her antibiotic course, a follow-up CXR showed near resolution of the RUL consolidative opacity with a few small residual lucencies in the RUL, presumed to be residual pneumatoceles (Figure 1D). She was asymptomatic without a cough, and her lung examination was normal. Inflammatory markers, including CRP and sedimentation rate, as well as white blood cell count and platelet count, were in the normal range. One month later, while the patient remained asymptomatic, a follow-up CXR revealed an enlarged pneumatocele (Figure 2A, B). A chest CT with IV contrast demonstrated a 7.2 x 5.3 x 7.6 cm air-filled cavity in the RUL (Figure 2C, D). No definite connection to the adjacent airways was seen on the chest CT. The patient then underwent a thoracoscopic right upper lobectomy. The procedure was challenging due to adhesions and bleeding (Figure 2E). The pathology examination of the resected lung tissue showed a simple fibrous-walled cyst devoid of epithelial lining, consistent with pneumatocele (Figure 2F). Gram stain, fungal smear, bacterial culture and fungal culture of the explanted lung tissue were negative. The patient made a full recovery, both radiologically and clinically.Patients with NP usually present with symptoms of CAP, unresponsiveness to initial outpatient treatment, such as high fever, cough, tachypnea, and general unwell appearance 1. The initial treatment of NP consists of IV antibiotics covering the most common etiologic agents of NP, which are known to be S. pneumoniae , Group AStreptococci and S. aureus . The optimal duration of antimicrobial therapy is not clearly defined; however, usually prolonged with a median duration of 4 weeks reported in the literature2, which aligns with guideline suggestions for therapy of empyema and parapneumonic effusion 3. Improvement in clinical and laboratory parameters usually allows for IV to oral antibiotic transition, which was accomplished relatively early for our patient, due to her less severe initial presentation and rapid clinical improvement. Pneumatoceles, air-filled cysts that can arise as a complication of NP, typically regress over weeks to months when NP is treated, but might require segmental or lobar resection if they become tense (exceeding more than 50% of the involved lobe), infected, or rupture 1. In our patient, many of the small pneumatoceles decreased in size after antibiotic treatment, with subsequent delayed and marked enlargement of one of them. A report on giant lung cysts emerging after NP suggested that, when patients remain clinically stable, treatment of pneumatoceles should be conservative with antibiotics alone regardless of the size of the cysts, as interventional procedures carry a risk of complications such as bronchopleural fistula 4. However, a study that proposed a treatment algorithm for pneumatoceles, recommended surgical resection for those that remained unresolved despite a conservative approach and gradually grew in size and wall thickness5. Our patient had no symptoms related to the pneumatocele. Nevertheless, it can be challenging to anticipate the progression of pneumatoceles, as they can enlarge enough to compromise respiration. The unusual expansion within a span of 1 month in our case, led to the decision of surgical resection.To summarize, we present a 3-year-old otherwise healthy girl with NP. After 4 weeks of antibiotic therapy, the right lung consolidations resolved and pneumatoceles decreased in size. However, one month later, while she remained clinically asymptomatic, a follow-up CXR revealed the progressive enlargement of a pneumatocele which eventually required surgical resection. Based on this experience, we suggest a close radiological follow-up of patients with post-infectious pneumatoceles, regardless of symptoms, until complete radiologic resolution is demonstrated.References1. de Benedictis FM, Kerem E, Chang AB, Colin AA, Zar HJ, Bush A. Complicated pneumonia in children. Lancet. 2020;396(10253):786–798. doi:https://doi.org/10.1016/s0140-6736(20)31550-62. Masters IB, Isles AF, Grimwood K. Necrotizing pneumonia: an emerging problem in children? Pneumonia (Nathan). 2017;9(1). doi:https://doi.org/10.1186/s41479-017-0035-03. Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C, Kaplan SL, Mace SE, McCracken GH, Moore MR, et al. The Management of Community-Acquired Pneumonia in Infants and Children Older Than 3 Months of Age: Clinical Practice Guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53(7):e25–e76. doi:https://doi.org/10.1093/cid/cir5314. Gross I, Gordon O, Cohen‐Cymberknoh M, Reiter J, Tsabari R, Gileles‐Hillel A, Erlichman I, Hevroni A, Shoseyov D, Kerem E. Giant lung cysts following necrotizing pneumonia: Resolution with conservative treatment. Pediatr Pulmonol. 2019;54(6):901–906. doi:https://doi.org/10.1002/ppul.243215. Imamoğlu M, Cay A, Koşucu P, Ozdemir O, Cobanoğlu U, Orhan F, Akyol A, Sarihan H. Pneumatoceles in postpneumonic empyema: an algorithmic approach. J Pediatr Surg. 2005;40(7):1111–1117. doi:https://doi.org/10.1016/j.jpedsurg.2005.03.048Authors and affiliations : Sila Y. Kocer 1, Nathan C. Hull MD 2, D. Dean Potter, Jr. MD3, Theresa Madigan MD 4, Jennifer M. Boland MD 5 and Nadir Demirel MD 61Ondokuz Mayis University School of Medicine, Samsun, Turkey2Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA. Email address: hull.nathan@mayo.edu3Division of Pediatric Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA. Email address: potter.d@mayo.edu4Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA. Email address: madigan.theresa@mayo.edu5Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA. Email address: boland.jennifer@mayo.edu6Division of Pediatric Pulmonology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA. Email address: demirel.nadir@mayo.eduConflict of interest: The authors declare no conflict of interest.

A growing number of studies have investigated the evolutionary drivers of external eye appearance in primates, but conclusive evidence is lacking. The literature has distinguished between two types of functions. Communicative functions, such as announcing a tame temperament via conjunctival depigmentation, and photo-regulatory functions towards the amount and quality of light in a given species' environment. Here, we assess the relative contribution of photo-regulatory and communicative functions to macaques' external eye appearance. Macaques' relatively well described social structure and wide distribution make them interesting to explore. We find that their sclera is more pigmented closer to the equator, suggesting photoprotective functions. However, this is not the case for the conjunctiva. We also explore individual variation in pigmentation adjacent to the iris, suggesting eyeball pigmentation in macaques is distributed to reduce damage to the corneal limbus. We find no evidence that communicative functions drive variation in external eye appearance in macaques.