Objective: To compare the carbon footprint of caesarean and vaginal birth. Design: Life cycle assessment. Setting: Tertiary maternity units and home births in the UK and the Netherlands Methods: A life cycle assessment, including: equipment use, energy, analgesia, hospital stay, waste, sterilisation and laundry, was conducted using primary data combined with data from published sources. Main Outcome Measures: ‘Carbon footprint’ (in kgCO 2e) Results: Excluding analgesia, the carbon footprint of a caesarean birth in the UK was 31.21 kgCO 2e, compared with 12.47 kgCO 2e for vaginal birth in hospital and 7.63 kgCO 2e at home. In the Netherlands the carbon footprint of a caesarean was higher (32.96 kgCO 2e), but lower for vaginal birth in hospital and home (10.74 and 6.27 kgCO 2e respectively). Emissions associated with analgesia for vaginal birth were: 0.08 kgCO 2e (opioid analgesia), 0.75 kgCO 2e (remifentanil), 1.2 kgCO 2e (epidural) and 237.33 kgCO 2e (nitrous oxide with oxygen). Differences in analgesia use resulted in a lower average carbon footprint for vaginal birth in the Netherlands than the UK (11.64 vs. 193.26 kgCO 2e). Conclusion: The carbon footprint of a caesarean is higher than for vaginal birth if analgesia is excluded, but this is very sensitive to the analgesia used; use of nitrous oxide with oxygen multiplies the carbon footprint of vaginal birth 25-fold. Alternative methods of pain relief or nitrous oxide destruction systems would lead to a substantial improvement in carbon footprint. Although clinical need and maternal choice are paramount, protocols should consider the environmental impact of different choices.

Objective: The aim of our present study is to investigate the role of plasmacytoid dendritic cells (pDCs) in the pathogenesis and type I interferon (IFN) signatures in Primary Sjögren’s Syndrome (pSS) patients. Methods: In the present study, we compared the percentage, activation markers, and representative cytokines secretion of pDCs derived from treatment-naive pSS and matched healthy controls (HCs) by flow cytometry. We performed pDC/B co-culture system to explore the contribution of pDC to B cell functions in pSS. Results: The percentage of pDC was significantly reduced in the peripheral blood of pSS. The activation markers (CD80, CD83, and CD86) expressions, chemokine receptors, and representative cytokines production (IFN-α, IL-6, and TNF-α) of pDC were similar between pSS and HCs. Only a few pDCs infiltration were detected in the labial gland. The percentage of pDCs was negatively correlated with serum IgG, IgA, and anti-SSA autoantibody levels and resting pDCs were able to efficiently promote B cells proliferation, activation, differentiation, and antibody production in vitro. However, there was no difference between HC and pSS-derived pDCs. Finally, we found that incubation of plasma from pSS patients could significantly induce pDCs apoptosis than that from HCs and both IgG and IgA dramatically increased the apoptotic rates of pDCs. Conclusion: Our data have deciphered the redundant role of pDC in the type I signature and disease development in pSS. Also, we demonstrated the decreased percentage of pDC in pSS patients might result from apoptosis induced by the excess of immunoglobulin (IgG and IgA).

Background Recent data support a relationship between gut microbiota and various chronic diseases, with emerging evidence indicating a similar association with skin microbiota. This study examined the impact of delivery method on skin microbiota and explored its effects on skin diseases and allergies. Sociodemographic characteristics, which are potential factors impacting skin microbiota, were also considered to investigate this relationship. Methods A cross-sectional study was conducted with 285 pediatric patients. The delivery method, allergy status, age, gender, consanguineous marriage and parental smoking exposure factors were questioned. The present diagnoses of the patients were also recorded. Categorical variables were analyzed using chi-square analysis and a binary logistic test was used for further analysis. Results An increased risk of infectious skin diseases (viral, bacterial, fungal) and allergies has been observed in cesarean section (p<0.001, p=0.057). The risk of scabies was higher in normal delivery (p=0.032). There was no significant relationship between the method of delivery and atopic or non-atopic dermatitis. For children born by cesarean section, parental smoking exposure and allergies were identified as factors increasing the risk of atopic dermatitis (p=0.045, p=0.018). Allergic children born by cesarean section exhibited a lower prevalence of infectious skin diseases (p=0.037). In addition, a decrease in infectious skin diseases from 21,2% to 10,3% was observed after 3 years of age in normal births (p=0,139). Conclusions Minimizing sociodemographic risk factors and creating a balanced and healthy microbiota, especially in early life, through personal and environmental measures, will be an important part of the treatment of skin diseases and allergies.

Anthropogenically induced habitat modification and climate change are fundamental drivers of biodiversity declines, reducing the evolutionary potential of species populations, particularly at the limits of their distribution ranges. Supportive breeding or reintroductions of individuals are often made to replenish declining populations, sometimes informed by genetic analysis. However, most approaches utilised (i.e. single locus markers) do not have the resolution to account for local adaptation to environmental conditions, a crucial aspect to consider when selecting donor and recipient populations. Here, we incorporate genetic (microsatellite) and genome-wide SNP (ddRAD-seq) markers, accounting for both neutral and adaptive genetic diversity, to inform the conservation management of the threatened common midwife toad, Alytes obstetricans at the northern and eastern edges of its range in Europe. We find geographically structured populations (n=4), weak genetic differentiation and fairly consistent levels of genetic diversity (observed heterozygosity and allelic richness). Categorising individuals based on putatively adaptive regions of the genome showed that the majority of populations are not strongly locally-adapted. However, several populations demonstrate high numbers of private alleles in tandem with local adaptation to warmer conditions and rough topography. Combining genetic diversity and local adaptations with estimates of migration rates, we develop a decision-making framework for selecting donor and recipient populations which maximises the geographic dispersal of neutral and adaptive genetic diversity. Our framework is generally applicable to any species, but especially amphibians, so armed with this information, conservationists may avoid the reintroduction of unsuitable/maladapted individuals to new environments and increase the evolutionary potential of populations within species.

We are concerned with the existence of global and blow-up solutions for the semilinear heat equation with variable exponent u t - Δ u = h ( t ) f ( u ) p ( x ) in Ω×(0 ,T) with zero Dirichlet boundary condition and initial data in C 0 ( Ω ) . The scope of our analysis encompasses both bounded and unbounded domains, with p ( x ) ∈ C ( Ω ) , 0 < p - ≤ p ( x ) ≤ p + , h∈ C(0 ,∞), and f∈ C[0 ,∞). Our findings have significant implications, as they enhance the blow-up result discovered by Castillo and Loayza in Comput. Math. App. 74(3), 351-359 (2017) when f( u)= u.

Mutualistic interactions are increasingly recognized as playing important roles in community assembly. We hypothesized that mutualisms can influence the accumulation of evolutionary history within communities through indirect interactions, which we investigated by quantifying the impact of mutualism gains and losses on phylogenetic structure in the Fabaceae family. Analyzing global distribution data, we find that legumes lacking mutualistic interactions exhibit reduced phylogenetic clustering, resulting in higher phylogenetic diversity in regions richer in non-mutualistic legumes. Moreover, the probability of a plant species being introduced to a new range is negatively related to phylogenetic distance to its nearest native relative, but this effect is weaker for species without mutualistic interactions. These findings highlight the significant role of mutualism in restricting the local distribution of evolutionary history at a global scale. Our study advances community assembly theory and underscores the importance of considering mutualism in the conservation and restoration of phylogenetic diversity.

A document by Dilek ÇELİK EREN. Click on the document to view its contents.

A document by Javier Calvo Torres. Click on the document to view its contents.

RATIONALE: SLAP is one of the two calibration materials for the isotopic water scale. By consensus the established δ 18O value is -55.5‰, although there are firm indications that δ 18O SLAP is significantly more negative. The real δ 18O SLAP value as such does not influence the isotopic water scale, however knowledge of the size of isotopic scale contraction in stable isotope measurements is vital for second order isotopes. In this study quantification of δ 18O SLAP with respect to δ 18O VSMOW is described. METHODS: SLAP-like water was quantitatively mixed with highly 18O enriched water to mimic VSMOW. The 18O concentration was determined using an electron ionization quadrupole mass spectrometer. The isotopic composition of the SLAP-like and VSMOW-like waters were measured with an optical spectrometer, alongside real VSMOW and SLAP. RESULTS: This study resulted in a much more depleted δ 18O value for SLAP than expected. The averaged outcome of 7 independent experiments is δ 18O SLAP -56.33 ± 0.03‰. There is a large discrepancy between the actual isotopic measurements of even the most carefully operating groups and the true δ 18O value. CONCLUSIONS: Although this finding as such does not influence the use of the VSMOW-SLAP scale, it raises the intriguing question what we actually measure with our instruments, and why even a fully corrected measurement can be so far off. Our result has consequences for issues like the transfer of δ 18O from and to the VPDB scale, various fractionation factors, and the Δ 17O. The absolute 18O abundance for SLAP was determined at 1.88798 (43) x 10 -3 based on the absolute 18O abundance of VSMOW and the presented δ 18O SLAP in this paper.

Treatment options for mild to moderate COVID-19 is limited. N-acetylcysteine and bromhexine have antiviral activity and show potential as treatment options against SARS-CoV-2 infections. This study evaluates the in vitro antiviral effect of bromhexine (BMX) for SARS-CoV-2 and determines the efficacy of treatment with BMX in combination with N-acetylcysteine (NAC) to reduce clinical scores in patients with mild to moderate COVID-19. Upon evidence from pre-clinical studies, a single center randomized trial of BMX + NAC (ClinicalTrials.gov Identifier: NCT04928495) with 420 participants in total took place in Fortaleza, CE, Brazil. Out of the 420 participants 140 received placebo, 140 received NAC alone, and 140 received NAC + BMX. Patients were monitored for 10-14 days, where physicians recorded all signs and symptoms reported. Nasopharyngeal swabs and blood samples were collected for SARS-CoV-2 RNA testing during the first visit, as well as 3 and 10 days after. Blood samples were collected at first visit and 10 days after for immuno-inflammatory biomarkers measurements. Treatment with NAC+BMX reduced clinical scores and symptoms when compared to placebo group (2/26; 8% vs 7/18; 39%; p < 0.05). Fever (≥37.8°C) was reduced by NAC + BMX treatment when compared to treatment with NAC alone and placebo. This study was limited by a largely vaccinated population. Our analysis showed that BMX reduces SARS-CoV-2 infection in vitro. Clinical trial results suggested that combinatory treatment with NAC + BMX is beneficial in mild to moderate COVID-19.

Identifying and understanding patterns of biological diversity is crucial at a time when even the most remote and pristine marine ecosystems are threatened by resource exploitation such as deep-seabed mining. Metabarcoding provides the means through which to perform comprehensive investigations of diversity by examining entire assemblages simultaneously. Nematodes commonly represent the most abundant infaunal metazoan group in marine soft sediments. In this meta-analysis, we compiled all publicly available metabarcoding datasets targeting the 18S rRNA v1-v2 region from sediment samples to conduct a global-scale examination of nematode Amplicon Sequence Variant (ASV) alpha diversity patterns, evolutionary distinctiveness (ED) and phylogenetic community structure at different depths and environments. We found that nematode ASV richness followed a parabolic trend, increasing from the intertidal to the shelf, reaching a maximum in the bathyal and decreasing in the abyssal zone. No depth- or environment-specific assemblages were identified as a large fraction of genera were shared. Contrastingly, the vast majority of ASVs were unique to each environment and/or depth zone; genetic diversity was thus highly localised. The abyssal samples had the highest ED values, indicating that a relatively stable yet very old environment can produce highly diversified assemblages. Overwhelmingly, nematode ASVs in all environments exhibited phylogenetic clustering, pointing to environmental filtering as the primary force defining community assembly rather than competitive interactions. This finding stresses the importance of habitat preservation for the maintenance of marine nematode diversity.

Metals pollution and channel disturbance associated with historical mining, land use, and water development degraded aquatic and riparian habitat along the upper Arkansas River near Leadville, Colorado. Stream restoration was conducted for an 8 km reach to improve aquatic habitat and increase trout populations. Instream structures were prescribed to stabilize streambanks, create diverse stream morphology, and provide overhead cover, refuge, spawning, and overwinter habitat for trout. At least 90% of all structures were expected to be stable and functional three years after implementation. The objectives of this study were to investigate structure performance by (1) evaluating the integrity and function of instream structures and (2) evaluating the change in residual pool depths (RPD). Annual surveys utilized a rapid assessment procedure to qualitatively rank integrity, erosion, and deposition at each structure (n = 137). Rankings were investigated with ordinal regression to determine if performance varied by structure type and year. Longitudinal profile surveys were conducted annually and used to estimate RPD for 86 pools. The change in RPD was investigated with repeated measures ANOVA to determine if RPD varied between structure types and changed over time. Results suggest that some structures were more prone to failure, with higher rankings observed for boulder toe, log vanes, log toe, and boulder vanes. Pool depths increased during construction, decreased following the first runoff, and then remained relatively stable in subsequent years. Understanding the performance of instream structures from this case study will help inform the design, evaluation, and expectations for future stream restoration projects.

This study was conducted to meet regulatory requirements under the Fisheries Act in Canada, specifically for a hydroelectric facility on the Yellowknife River in the Northwest Territories. The research focused on annual snorkel surveys of adfluvial fish and their spawning habitat below the facility. Initial observations of egg mortality, potentially due to overcrowding, prompted the investigation of natural and enhanced habitat for spawning Lake trout ( Salvelinus namaycush), lake whitefish ( Coregonus clupeaformis) and cisco ( Coregonus artedi) from 2016 to 2019. The design and composition of the installed habitat were based on fish utilization of the natural channel below the hydro facility and design principles from previous habitat rehabilitation projects for anadromous fishes. Pre- and post-enhancement data on egg density and survival were collected using 1 m 2 plots on both natural and artificially enhanced substrates. Three years of post-enhancement monitoring indicated higher egg densities and a greater proportion of live eggs in the artificially enhanced habitat compared to the natural habitat, with more pronounced trends observed for coregonids (lake whitefish and cisco) compared to lake trout. These findings suggest that habitat enhancement has the potential to enhance juvenile recruitment for adfluvial fish. A critical factor in the design was the substrate composition, providing adequate interstitial spaces for egg development and protection. This study represents the first documented attempt at habitat improvement in a regulated sub-Arctic river in Canada. The findings offer valuable guidance for stakeholders involved in new or existing development projects that require conservation actions to maintain fisheries productivity.

A document by Yiming Zeng. Click on the document to view its contents.

Background and Purpose: Adenomyosis causes pain, abnormal bleeding, and infertility. Epithelial-mesenchymal transition (EMT) plays a critical role in the pathogenesis of adenomyosis. Current therapies are mainly hormone-dependent and their termination led to aggravations. To develop novel pharmacological treatment is necessary. Safflower was widely used to treat gynecological disease in China, the effect of hydroxysafflower yellow A (HSYA) that is the major active component of Safflower on adenomyosis remains unclear. We investigated whether HSYA ameliorates adenomyosis, and further revealed its potential target and mechanisms. Experimental Approach: Adenomyosis was induced in female ICR mice by oral administration of tamoxifen on days 2-5 after birth. At the 16th week, HSYA were administrated for 3 weeks. Adenomyosis development, autophagy activity, and involved mechanisms were analyzed using HE and Masson staining, western blotting, immunofluorescence, and RNA-sequencing. Furthermore, network pharmacology and molecular docking were applied to assess the potential target of HSYA. Key Results: HSYA ameliorates adenomyosis via promoting autophagy and ameliorating the activation of PI3K-AKT-mTOR. Isocitrate dehydrogenase1(IDH1) was found to be the potential target of HSYA. After IDH1 was knocked down by si-RNA, autophagy was activated, and EMT was attenuated via inhibiting PI3K-AKT-mTOR by HSYA. Conclusions and Implications: HSYA significantly ameliorates adenomyosis, and IDH1-autophagy-EMT plays an important role in the progress of adenomyosis. It will shed new light on a potential novel therapeutic strategy for adenomyosis.

Asymptomatic congenital Bronchial Pulmonary Arterial vascular malformation in an Adult.

IntroductionCoronavirus belongs to RNA viruses that cause respiratory, neurologic, enteric, and hepatic diseases distributed among mammals, including humans and birds (1). A novel coronavirus discovered in late 2019 in China caused Coronavirus Disease 2019 (COVID-19). It is associated with complications like severe viral pneumonia, ARDS, AKI, cardiac injury, liver dysfunction, spontaneous pneumothorax, lung cavitation, pleural effusion, pericardial effusion, along with other minor ailments like fever, loss of smell, myalgia, dry cough, lymphadenopathy (2) (3).Pneumothorax due to COVID-19 pneumonia is very rare, and few cases are reported with bronchopleural fistula-associated persistent pneumothorax while recovering from COVID-19 pneumonia (4) (5) (6).

：Immunotherapy has been an advanced and effective approach to treating various types of solid tumors in recent years, and the most successful strategy is immune checkpoint inhibitors (ICIs), which have shown beneficial effects in patients with colorectal cancer (CRC). Drug resistance to ICIs is usually associated with CD8 + T-cells targeting tumor antigens; thus, CD8 + T-cells play an important role in immunotherapy. Unfortunately, Under continuous antigen stimulation, tumor microenvironment(TME), hypoxia and other problems it leads to insufficient infiltration of CD8 + T-cells, low efficacy and mechanism exhaustion, which have become obstacles to immunotherapy. Thus, this article describes the relationship between CRC and the immune system, focuses on the process of CD8 + T-cells production, activation, transport, killing, and exhaustion, and expounds on related mechanisms leading to CD8 + T-cells exhaustion. Finally, this article summarizes the latest strategies and methods in recent years, focusing on improving the infiltration, efficacy, and exhaustion of CD8 + T-cells, which may help to overcome the barriers to immunotherapy.

Electrocatalytic reduction of CO2 to fuels and chemicals possesses huge potential to alleviate current environmental crisis. Heteroatom doping in metal-nitrogen-carbon (M-N-C) single-atom catalysts (SACs) has been found capable to promote the electrocatalytic CO2 reduc-tion reaction (CO2RR). However, the origin of the enhanced activity is still elusive. Here, we report that sulfur-doped cobalt-nitrogen-carbon single-atom catalyst (Co1-SNC) exhibits superior CO2RR performance compared to sulfur-free counterpart (Co1-NC). On the basis of in situ attenuated total reflectance surface-enhanced infrared absorption spectroscopy (ATR-SEIRAS), kinetic isotope effect (KIE) and theoretical calculation, it is demonstrated that sulfur doping can promote water activation, elevate the d-band center of Co active site, and reduce the free energy of *COOH intermediate formation. This work deepens the understanding of the CO2RR chemistry over heteroatom-doped SACs for designing efficient CO2RR processes.

Due to environmental concerns, interest in bioplastics is rising. For optical applications, materials have to meet high requirements. Polylactide (PLA), a known bioplastic, is already applied in high tech applications such as medicine. The material shows favorable optical properties and excellent resistance against photodegradation. However, the material turns hazy due to crystallization when exposed to temperatures above 55-60 °C. This renders it useless for optical applications. Clouding might be avoided by influencing PLA’s crystallization behavior. In this critical review the broad use of PLA is discussed. It is also shown, that currently no material is commercially available that meets all requirements set while being biodegradable and exclusively based on renewable feedstocks. Finally, an overview of the current state in research is provided, considering PLA-based materials with adapted crystallization behavior under the aspect of transparency. At last, recommendations for the goal of achieving highly sustainable PLA-based optical components are given.

Among organic phase change materials, paraffin is most commonly used, but it is not environmentally friendly due to its petrochemical content. For efficient utilization of solar or thermal energy, new phase change materials are urgently needed, or it is necessary to improve the thermal properties of existing materials. Therefore, the utilization of lamb’s tail fat as a latent heat storage material is of particular importance for the evaluation of bio based waste oils. T-history is one of the simplest and most reliable and the simple equipment setup and reliable results make the T-History method attractive. In this study, new phase change materials were improved by using different concentrations of cyclophosphazene derivatives as an additive to the starting lamb tail fat material. According to the results, 1% HEHCP-doped lamb tail fat can be proposed for application in thermal energy storage systems when used for insulation. In addition, it is found that if the phase change materials developed by inclusion of HBACP can be operated as cooling liquid for photovoltaic panels or as working fluid in concentrated solar power systems, owing to higher fusion of heat value of 1% HBACP and higher specific heat capacity of 2% HBACP consisting lamb tail fat.

Covid-19 has given us a new way to look at our globe with regards to minimize air and noise pollution and thereby upgrading global environmental conditions. This positive pandemic outcome indicates that green energy is the future of energy, and one new origin of green energy is lithium-ion batteries (LIBs). Electric vehicles are constructed with LIBs, but they have a number of disadvantages, including poor thermal performance, thermal runaway, fire dangers, and a higher discharge rate in low- and high-temperature conditions. The underlying fault of LIBs is their temperature reactivity. Extreme temperatures and challenging working circumstances can cause lithium-ion cells to malfunction and cause the battery pack to overheat. For optimal performance in vehicles and long-term lithium-ion battery durability, LIBs must be thermally managed within their operating temperature span. This paper presents an overview of several cooling strategies used to maintain the internal battery pack temperature. This paper discusses cooling techniques using air, liquid, and Phase Change Material (PCM), Heat pipe(HP). Additionally, various battery pack configurations and heat generation techniques are explored. This research also discusses the usage of nanomaterials to address the battery pack’s heat-related problems. This study emphasises the use of nanomaterial to boost the heat conductivity of coolant in order to raise the batteries temperature into their ideal working range (PCM as well as LC). This article also provides some of the research gaps that have been found and the crucial areas on which attention should be directed in order to build the best lithium-ion BTMS technology.

We analyzed refraction and reflection seismic data covering the Central Lau Spreading Center (CLSC) and the Tonga volcanic arc at 18 °S to investigate tectonic inactivity in actively extending back-arc systems. Our P-wave travel time tomography shows a characteristic 6-8 km thick back-arc crust beneath and around the CLSC and a ~13 km thick arc-crust at the eastern end of our profie. Lower crustal velocities increase to 7.5 km/s towards the volcanic arc, marking the change from back-arc to arc crust. These high P-wave velocities can be explained by a high pyroxene continent in the lower crust originating from depleted metls. Our seismic reflection data show steep normal faults below the CLSC and volcanic structures closer to the volcanic arc, without a tectonically active zone (also knows as the ‘diffuse plate boundary’) in between, hence the Niuafo’ou and Tonga microplates should be treated as one tectonic plate with local zones that deform, but that are not fully developed plate boundaries. We build on the concept that cold, depleted mantle material may invade the back-arc domain, and argue that this invading mantle material cools the overriding plate with increasing distance from the trench leading to 1) relative strengthening of the overlying back-arc crust, b) relocalisation of extension and c) tectonic quiescence in previously active extending parts of the back-arc domain.

Early Childhood Atopic Phenotypes and the Development of Allergic Respiratory DiseaseTo the Editor,Pediatric atopic dermatitis (AD) is a chronic, pruritic, inflammatory skin disorder that affects up to 20% of children worldwide1. Often the earliest sign of atopy, AD has been recognized as the start of the “atopic march”, described as the progression of AD to allergic respiratory diseases (ARD) including asthma and allergic rhinitis2. Although these atopic conditions often share a common T2 enriched pathway influenced by both genetic and environmental factors, not all children with AD have subsequent risk of ARD. Additionally, recent investigations dispute the theory that the temporal progression of the atopic march occurs in a sequential pattern3. Early AD can facilitate allergen sensitization due to a dysfunctional skin barrier4. Both aeroallergen and food sensitization has been associated with risk of ARD5, but it is less clear whether AD may partially mediate that risk. Additionally, food allergy has been recognized to be part of the atopic march, however its role in the march to ARD is less well identified. It is also unclear how these risks may appear in ethnically diverse populations. Distinct atopic phenotypes may better predict risk of ARD. Our objective was to identify whether associations between early food sensitization, aeroallergen sensitization, or food allergy (FA) and the subsequent risk of ARD by age 10 was modified by the development of early AD by age 2 years.We analyzed data from our racially and socioeconomically diverse birth cohort, Wayne County Health, Environment, Allergy and Asthma Longitudinal Study (WHEALS) that enrolled pregnant women 21–45 years of age and their offspring. Recruitment period was from September 2003–December 2007. Eligibility and recruitment are described in previous publications 6 and all study protocols were approved by the Henry Ford Health System Institutional Review Board.Offspring sensitization to aeroallergens (Alternaria, cat, cockroach, dog, Dermatophagoides farina, ragweed, timothy grass), milk, egg, or peanut was determined at 2 years of age by sIgE≥0.35 IU/mL and skin prick testing (SPT; wheal size ≥3 mm larger than the saline control defined a positive test). As sensitization does not always translate to clinical allergy, we also formed an algorithm to determine those most likely to have true IgE-mediated food allergy7. Two allergists reviewed subjects with at least one of the following criteria: (1) at least one food (milk, egg or peanut) with sIgE ≥0.35 IU/mL; (2) a positive SPT; or (3) parental report of infant symptoms potentially related to food allergy plus at least one sIgE >0.10 IU/mL. To standardize classifying infants to the presence of IgE-mediated food allergy (IgE-FA), physicians were asked to combine professional experience with investigator-developed protocols based on the Guidelines for the Diagnosis and Management of Food Allergy in the United States8. A third allergist independently reviewed and ruled on discordant decisions. Data on asthma and AR by age 10 diagnosed by the study physician was collected using clinical history, physical exam, spirometry, and methacholine test.Adjusted relative risk (aRR) was calculated using Poisson regression with robust error variance and following adjustment for sex, child’s race, parental history of asthma, parental history of AR, BMI z-score at age 2, delivery mode, 1-month breastfeeding status, prenatal indoor dog exposure, prenatal indoor cat exposure, and 1-month daycare status.Of the 1258 mother-child pairs enrolled in WHEALS, 347 had sufficient data for analyses (Supplemental Figure 1). Demographics are shown in Table 1. The overall rate of early AD by age 2 years was 25.4% (88 out of 347 subjects). Supplemental Table 1 shows the overall rates of asthma and allergic rhinitis by age 10 by 2-year AD status. AD by age 2 years significantly modified the association between FA at 3-5 years and the risk of ever having asthma by age 10 (p=0.027) (Figure 1). In the absence of AD, FA to milk, egg, or peanut was associated with an increased risk of ever having asthma (aRR 3.36(1.71, 6.58), p<0.001), while no difference was observed in the presence of AD (aRR 1.24(0.57, 2.68), p=0.99). Food sensitization in the absence of AD was associated with increased risk of ever asthma (aRR 2.04(1.03, 4.05), p=0.038), but was not associated with ever AR (aRR 1.10(0.81, 1.48), p=0.97). Food sensitization in the presence of AD was not associated with ever asthma (aRR 0.89(0.45,1.78), p=0.99) or ever allergic rhinitis (aRR 1.45(0.97-2.16), p=0.078).In terms of aeroallergen sensitization, AD by age 2 did not significantly modify the association between aeroallergen sensitization at age 2 and the risk of ARD by age 10. This was true for aeroallergen sensitization overall and when sub-analyzed by seasonal versus perennial (Table 2, Figure 1). However, among those without AD by age 2, perennial aeroallergen sensitization was associated with an increased risk of ever having asthma by age 10 (aRR 2.15 (1.06, 4.36), p=0.031). This association was not significant for those with AD by age 2 (aRR 1.68 (0.78, 3.63), p=0.26).Our findings among a racially and socioeconomically diverse birth cohort suggest that early AD modifies the relationship between FA and the risk of ever having asthma by age 10. However, the association between FA and increased risk of ever having asthma was only seen among those without AD by age 2, which does not support the previously reported atopic progression of disease as described by the atopic march. This held true after correcting for several environmental and parental factors that may increase risk of ARD in our cohort. Our findings may represent a distinct atopic phenotype more characteristic among non-White subgroups, as our cohort is 67% self-identified Black. Previous reports have highlighted the differences in AD phenotypes among ethnically diverse subgroups9. Additionally, recent reports highlight atopic trajectories differ among White and Black children, with Black children more likely to have asthma without FA, AR, or allergen sensitization10. Due to sample size, we were unable to assess the differing trajectories in whites versus blacks. However, because our cohort is composed of 64.8% black children, we believe that black race may be contributing to the outcomes of our study as previous studies have reported atopic trajectories that are different in Black children10. Future studies investigating these endotypes that differ by ethnicity would be beneficial to identify potential immunological markers that would guide therapies for ethnically diverse populations and allow appropriate anticipatory guidance.Keywords : Atopic march, atopic dermatitis, food allergy, food sensitization, aeroallergen sensitization, asthma, allergic rhinitisKey message: Identifying early atopic phenotypes may help identify later ARD risk. This study reiterates that the “march” is not always a chronological process, but rather a complex relationship between heterogenous allergic phenotypes.