Septic foals may present diagnostic conundrums as their clinical presentation can vary from normal to comatose. While the comatose, hypothermic foal with swollen joints is easy to identify as septic, bright foals may require additional diagnostics such as bloodwork, radiographs, or ultrasonography. Treatment of neonatal septicemia is led by the need for supportive care and selection of appropriate antimicrobial therapy. Antimicrobial pharmacology in foals differs significantly from adult horses due to the lack of hindgut fermentation development. Foals respond to many medications similarly to other common domestic species, the cat and dog, until their adult gastrointestinal tract is developed. As such, care should be taken whenever administering antibiotics for a sick neonatal foal. The goal is to avoid medications that maybe damaging to a developing animal and consider their differences in medication absorption and pharmacology. The prognosis for septic foals varies extensively based on the cause of the disease, promptness in starting therapy, and complications. In most cases the prognosis is improved the more quickly treatment is initiated. Therefore, sick foals should be treated as emergencies.

Species distribution models (SDMs) have been widely used to project terrestrial species’ responses to climate change and are increasingly being used for similar objectives in the marine realm. These projections are critically needed to develop strategies for resource management and the conservation of marine ecosystems. SDMs are a powerful and necessary tool; however, they are subject to many sources of uncertainty. To ensure that SDM projections are informative for management and conservation decisions, sources of uncertainty must be considered and properly addressed. Here we provide ten overarching guidelines that will aid researchers to identify, minimize, and account for uncertainty through the entire model development process, from the formation of a study question to the presentation of results. These guidelines were developed at an international workshop attended by over 50 researchers and practitioners. Although our guidelines are broadly applicable across biological realms, we provide particular focus to the challenges and uncertainties associated with projecting the impacts of climate change on marine species and ecosystems.

CD19-directed chimeric antigen receptor T lymphocytes (CAR-T) have led to durable remissions in children with refractory and/or multiply relapsed B-lymphoblastic leukemia. For those who relapse or lose B-cell aplasia post-CAR-T, the role of CAR-T reinfusion is unclear. We report a case of durable remission with tisagenlecleucel reinfusion despite failure to achieve B-cell aplasia and compare this case to seven additional children who received multiple tisagenlecleucel infusions at our institution. Our experience suggests that reinfusion is safe and may be a definitive therapy for a small subset of patients. Reinfusion can also reintroduce remission and/or B-cell aplasia, allowing for subsequent therapies.

The therapeutic effects of human mesenchymal stromal cells (MSC) have been attributed mostly to their paracrine activity, exerted through small-secreted extracellular vesicles (EVs) rather than their engraftment into injured tissues. Currently, the production of MSC-derived EVs (MSC-EVs) is performed in laborious static culture systems with limited manufacturing capacity using serum-containing media. In this work, a serum-/xenogeneic-free microcarrier-based culture system was successfully established for bone marrow-derived MSC cultivation and MSC-EV production using a 2 L-scale controlled stirred tank reactor (STR) operated under fed-batch (FB) or fed-batch combined with continuous perfusion (FB/CP). Overall, maximal cell numbers of (3.0±0.12)×10 8 and (5.3±0.32)×10 8 were attained at days 8 and 12 for FB and FB/CP cultures, respectively, and MSC(M) expanded under both conditions retained their immunophenotype. MSC-EVs were identified in the conditioned medium collected from all STR cultures by TEM, and EV protein markers were successfully identified by WB analysis. Overall, no significant differences were observed between EVs isolated from MSC expanded in STR operated under the two feeding approaches. EV mean sizes of 163±5.27 nm and 162±4.44 nm (P>0.05) and concentrations of (2.4±0.35)x10 11 EVs/mL and (3.0±0.48)x10 11 EVs/mL (P>0.05) were estimated by nanoparticle tracking analysis for FB and FB/CP cultures, respectively. The STR-based platform optimized herein represents a major contribution towards the development of human MSC- and MSC-EV-based products as promising therapeutic agents for Regenerative Medicine settings.

Objectives: The e-prescribing risk and safety evaluation (ePRaSE) tool was developed to support the evaluation of hospital e-prescribing systems. The tool uses fictitious patients alongside previously validated prescribing scenarios to detect whether these systems provide prescribing advice to users, when completing inpatient prescribing tasks. We sought to evaluate the usability and acceptability of ePRaSE for clinical informatics pharmacy staff using different e-prescribing systems in NHS hospitals across England. Materials and methods: All NHS hospitals in England with live e-prescribing systems were invited to participate via an email invitation to the chief pharmacists. Participants were asked to complete the four-stage ePRaSE assessment, whilst verbalising their thoughts and sharing their perspectives on the acceptability and usability of the assessment. The data were transcribed verbatim, coded and analysed using the Framework Approach. Results: Ten participants from ten different hospitals across England conducted the ePRaSE assessment between April and December 2019. They completed the assessment in 2-3 hours and described the tool as easy to use and the prescribing scenarios as clinically relevant. However, some participants experienced difficulties inputting clinical data, such as laboratory results, often due to restricted access to input data into different parts of the electronic health record. Many participants suggested areas for further improvement and suggested more detailed results on completion of ePRaSE was desirable. Conclusions: E-prescribing system users found ePRaSE to be a useful and acceptable tool. Further work to refine the tool is desirable, particularly relating to the provision of results to ePRaSE users.

Abstract Objective To compare the gestational age of neonates in utero exposed to benzodiazepines (BDZs) with none exposed controls. Secondary objectives were; birth weight, presence of congenital malformations, APGAR score, and the need for > 3 months (prolonged) maternal psychiatric care. Study design A retrospective cohort study of women and neonates from 2013 to 2021 with univariate and multivariable analysis to study the associations between BDZs exposure and gestational age compared to non-exposed women with mental health problems. Results We found that BDZ exposure was associated with a lower gestational age of -3.2 days (95% CI -5.8 , -0.53 days). Women in the exposed group had an increased risk of psychiatric care (adjusted OR 2.511 (95% CI 1.675 – 3.782), p < 0.001). Conclusion We found that in utero BDZ exposure was independently associated with a significantly lower gestational age of the neonates and prolonged psychiatric care of their mothers.

Warts, caused by human papillomavirus (HPV) infection, have various clinical presentations, making them difficult to differentiate from clavus, callus, and sometimes squamous cell carcinoma. Although skin biopsies are the gold standard, a less-invasive method of examining these lesions is desired. Ninety patients with warts and related diseases, such as corns and callus, were collected to explore new differentiation methods using the surface of the warts. DNA was extracted from three types of specimens in each case: surface swab, shaved hyperkeratotic scale, and post-shaved surface swab. We then analyzed samples for the HPV type and HPV viral load using polymerase chain reaction (PCR). Fifty-five cases were PCR-positive, and HPV1a, 2a, 4, 27, 57, and 65 were detected. The amount of HPV1a DNA produced was significantly greater than that of other HPV types. Regarding the correlation between the clinical diagnosis and HPV detection, the positive agreement rate was 90.9%, the negative agreement rate was 40.0%, and the overall agreement rate was 71.1%. Ten of the 21 cases clinically diagnosed as plantar warts were PCR-negative, especially in elderly patients. Although the amount of HPV DNA in the removed keratinization scale was highest for all HPV types, HPV detection by swabbing before and after shaving is also useful for follow-up as well as the differential diagnosis.

Objective This study aimed to determine the correlation between interpregnancy interval (IPI) and neurodevelopmental delay in infants and to explore the potential mediating role of maternal-fetal glucose metabolism. Design Population based cohort study. Setting China Participants A total of 2559 mother-infant pairs between 2018 and 2022. Methods The prospective birth cohort study included 2559 mother-infant pairs. The IPI is calculated by subtracting the gestational age of the current pregnancy from the interval at the end of the previous pregnancy. Maternal fasting venous blood collection at 24-28 weeks and cord blood collection at delivery. The association between IPI and neurodevelopment was determined by logistic regression. Main outcome measures Neurodevelopmental outcomes at 12 months in offspring were assessed by the Ages and Stages Questionnaire Edition 3 (ASQ-3). Results In our cohort, 14.0% had an IPI <12 months. IPI <12 months increased the failure of the communication domain, fine motor domain, and personal social domain of the ASQ [relative risks (RRs) with 95% confidence interval (CI): 1.75(1.13, 2.72); 1.77(1.13, 2.77); 1.51(1.01, 2.28)]. Maternal homeostasis model assessment of insulin resistance (HOMA-IR) and cord blood C-peptide was significantly associated with failure in the communication domain [RRs with 95% CI: 1.15(1.02, 1.31); 2.15(1.26, 3.67)]. The proportion of the association between IPI and failure of the communication domain risk mediated by maternal HOMA-IR and cord blood C-peptide was 14.4%. Conclusions IPI <12 months was associated with failing the communication domain in offspring. Maternal-fetal glucose metabolism abnormality may partially explain the neurodevelopmental delay caused by short IPI.

Objective: Fetal and neonatal alloimmune thrombocytopenia (FNAIT) results from maternal platelet-directed antibodies which can cause severe intracranial haemorrhage (ICH) in fetuses and new-borns. Screening for human platelet antigen-1a (HPA-1a) directed antibodies during pregnancy could allow for timely intervention with antenatal treatment and prevent the occurrence of ICH. We aim to assess the cost-effectiveness of adding screening for anti-HPA-1a to the prenatal screening program. Design: A decision analysis model was developed. Setting: The Netherlands. Population: 171,713 pregnant women. Methods: Lifetime costs and effects of antenatal anti-HPA-1a screening with subsequent diagnostic and treatment interventions were compared to the current situation without screening in the Netherlands. Model parameters were based on literature and expert opinions. One-way-sensitivity analysis and probabilistic sensitivity analysis were performed. Main Outcome Measures: Incremental cost-effectiveness ratio (ICER). Results: Adding screening for HPA-1a antibodies to the current antenatal screening program of the Netherlands will lead to an additional cost of 4.7 million euro and a gain of 226 Quality-Adjusted Life Years (QALY) per year, indicating an ICER of \euro20,782 per QALY gained. One-way sensitivity analysis showed that the uncertainty around the incidence of ICH, lifetime costs of disabled children and the probability of having antibody quantitation >3.0 IU/ml at 20 weeks had the highest effect on the ICER. Conclusion: Antenatal HPA-1a screening might be cost-effective. To obtain more knowledge and thereby reduce the uncertainty on risk stratification, a pilot screening program is warranted. Funding: Sanquin

Despite of superior performance of the oxide-derived copper (OD-Cu) in producing valuable hydrocarbons during CO2RR, its fabrication process is still ambiguous and complicated. In this work, we develop a simple microwave-assisted method to synthesize the oxide-derived Cu nanosheet (OD-Cu NS) and reveal that the oxidation state of Cu species is controlled by varying the Cu precursor amount. Notably, the simultaneous formation of nano-sized Cu domains influence the surface roughness of OD-Cu NS. The partially oxidized Cu surface exhibits a superior faradaic efficiency (FE) of C2+ products up to 72%, along with a partial current density of 55 mA cm−2 in a neutral KHCO3 solution. More importantly, the as-obtained OD-Cu NS shows a synergetic effect on dissociating of CO2 molecules by the strong binding energy and promoting of C2+ compounds productivity by the enlarged electrochemical surface area. This work provides a new insight for designing efficient OD-Cu catalysts towards CO2RR.

Some transformations acting on radially symmetric solutions to the following class of non-homogeneous reaction-diffusion equations | x | σ 1 ∂ t u = ∆ u m + | x | σ 2 u p , ( x , t ) ∈ R N × ( 0 , ∞ ) , which has been proposed in a number of previous mathematical works as well as in several physical models, are introduced. We consider here m≥1, p≥1, N≥1 and σ 1 , σ 2 real exponents. We apply these transformations in connection to previous results on the one hand to deduce general qualitative properties of radially symmetric solutions and on the other hand to construct self-similar solutions which are expected to be patterns for the dynamics of the equations, strongly improving the existing theory. We also introduce mappings between solutions which work in the semilinear case m=1.

Pea proteins are being widely investigated as a potential substitute for animal proteins due to health benefits and sustainability concerns. However, the limitations associated with functional properties of pea protein such as low solubility, result in poorer overall performance and render it less desirable for food applications such as plant-based milk, cream, or meat products. Different methods have been extensively studied to solve this issue. This review summarises recent and popular physical, chemical, and biological treatments used to modify the functional properties of pea proteins. The aim is to identify successful treatments, gaps in knowledge, and presenting a comprehensive analysis in methods to improve pea protein functionalities and the results after these treatments. It was concluded that chemical modification is by far the most effective in improving the solubility, emulsifying, and foaming properties of pea proteins, followed by biological treatment. The combination of different treatment methods, moreover, has shown some degree of success and provides a wider scope to improve pea protein functionalities, as a promising avenue for future studies.

To date no single gas chromatographic method can simultaneously measure all fatty acids (FA), including trans FA (TFA), that are contained in dairy products, partially hydrogenated oils (PHO), and refined vegetable oils. Using 100% poly(biscyanopropyl siloxane) capillary columns, ruminant and dairy fats are preferentially analyzed by applying temperature programs that separate short chain FA, but not trans-18:3 from 20:1. Refined vegetable oils and PHO are preferentially analyzed by applying isothermal elutions that provide quantification of all 18 carbon TFA including trans-18:3 FA, but not of all short chain FA. In this short communication, we propose a temperature program method capable of simultaneously measuring short chain FA and all 18 carbon TFA including trans-18:3 by applying a negative temperature gradient after the elution of trans-18:1. A simplified version of the method is also described for equipment not able to perform negative temperature gradients.

In this study, the effects of solid-state fermentation (SSF), including strain (Aspergillus niger NRRL 334 and A. oryzae NRRL 5590) and fermentation time (24, 48, and 72 h) on the nutritional value of cold-pressed (CP) and hexane-extracted (HE) canola meals were examined. SSF increased the protein content of both types of meals (from ~36 to ~40%) while reducing the oil content of CP meals (from ~12 to 9%). There was a significant reduction (~80%) in the phytic acid content of both types of meals after fermentation using either fungi. Overall, fermented samples showed a decrease in the total phenolic content from 2.7-3.1 to ~1.0 mg gallic acid equivalents (GAE)/g DM (a ~65% reduction), of which specifically the HE meal fermented with A. niger sample had the greatest decrease from 3.1 to 0.6 mg GAE/g DM (~81% reduction). Seventy-two hours of fermentation decreased the in vitro protein digestibility (IVPD) of the meals. In contrast, a shorter fermentation time (24 h) increased the IVPD as compared to the controls (from ~73% to 77-81%), with the exception of the CP meal fermented with A. niger which had decreased IVPD at all fermentation times. Overall, the changes indicate that SSF using A. niger or A. oryzae can be useful to positively modify the composition of different canola meals and improve their nutritional value by significantly increasing the protein content, decreasing the levels of antinutrients, while only slightly reducing IVPD.

it was aimed to treat a male patient aged 12 years and 1 month with Skeletal Class III anomaly characterized by maxillary retrognathia and achieve Skeletal Class I bite without the need for future orthognathic surgical procedures. With the application of the face mask, a successful treatment was achieved.

Averaging multiple event-related potential (ERP) segments distorts the brain’s response to a stimulus given the false assumptions that the ERP signal is invariant and hidden by background noise. Our Single Trial Peaks (STP) procedure measures amplitude and latency of multiple peaks in each segment based on the peak latencies of the individual’s averaged ERP. This study examined correct trial data from 70 adults performing two repetitions of a speeded visual flanker task. STP peak data (P1, N1, P2, N2, and P3) were compared to single-trial averaged voltage in time windows (STW) and peaks of averaged ERPs. Results indicated that the STP approach had higher split-half reliability (odd-even, r =.70-.96) and test-retest reliability (r =.66-.97) than the STW approach. The mean signal/noise ratios for the amplitude measures for the STP ranged from 1.62 to 2.9 and were larger than the STW approach, although averaged ERPs had higher ratios than both. Coefficients of variation (CV) for the STP and STW approaches were similar, and both had smaller CVs than averaged ERPs. The validity of the STP approach was determined by regression analyses where mean trial-level peak amplitude, SDs across trials for amplitude and latency, and noise accounted for a significant amount of variance in corresponding peaks of the averaged ERPs (R2 =.73-.95). Curve fitting analyses showed nonlinear systematic patterns in amplitude over trials similar to changes in response time. These results support the validity of the STP approach which can be used to investigate systematic changes of brain activity across trial.

Septicemia can be a tragic illness in neonatal and young foals. Sick foals may manifest a variety of clinical symptoms all related to a common infection and its systemic effects. While the pathogenesis of this disease is the same as for adult equids, the clinical signs seen can be very different. The rapid changes seen in foal are reflective of their low endogenous reserves of glucose and innate immune mediators as well as the poor ability to self-regulate their metabolism. The neonatal immune system is reliant on maternal antibodies at birth and development of the foal's own system takes a significant amount of time. This non-competent immune system changes how the foal responds to infection when compared to the adult. Clinical signs in septic foals include tachycardia, tachypnea, depression, anorexia, colitis, and fever. Less commonly, foals may show petechiation, swollen joints, anterior uveitis, and coma. This article is the first of a two part series on neonatal sepsis and will present a review on the neonatal immune system, the pathophysiology of sepsis, and the range of clinical signs seen in foals.

The tendency to ruminate (i.e., repetitive, self-referential, negative thoughts) is a maladaptive form of emotional regulation and represents a transdiagnostic vulnerability factor for stress-related psychopathology. Vagally-mediated heart rate variability (HRV), reflecting parasympathetic nervous system activity, is commonly used as a physiological marker of stress regulation. Past research has suggested a link between trait rumination and resting HRV at baseline; however, inconsistent results exist in healthy individuals. In this study, we investigated the association between the tendency to ruminate and resting HRV measured at baseline in a healthy population using a large cross-sectional dataset (N = 1189, 88% women; mean age = 21.55, ranging from 17 to 48 years old), which was obtained by combining samples of healthy individuals from different studies from our laboratory. The results showed no cross-sectional correlation between resting baseline HRV and trait rumination (confirmed by Bayesian analyses), even after controlling for important confounders such as gender, age, and depressive symptoms. Also, a nonlinear relationship was rejected. In summary, based on our results in a large sample of healthy individuals, baseline resting HRV is not a trait marker of the tendency to ruminate.

Permafrost regions are under particular pressure from climate change resulting in widespread landscape changes, which impact also freshwater chemistry. We investigated a snapshot of hydrochemistry in various freshwater environments in the lower Kolyma river basin (North-East Siberia, continuous permafrost zone) to explore the mobility of metals, metalloids and non-metals resulting from permafrost thaw. Particular attention was focused on heavy metals as contaminants potentially released from the secondary source in the permafrozen Yedoma complex. Permafrost creeks represented the Mg-Ca-Na-HCO 3-Cl-SO 4 ionic water type (with mineralisation in the range 600-800 mg/L), while permafrost ice and thermokarst lake waters were the HCO 3-Ca-Mg type. Multiple heavy metals (As, Cu, Co, Mn and Ni) showed much higher dissolved phase concentrations in permafrost creeks and ice than in Kolyma and its tributaries, and only in the permafrost samples and one Kolyma tributary have we detected dissolved Ti or Hg. In thermokarst lakes, several metal and metalloid dissolved concentrations increased with water depth (Fe, Mn, Ni and Zn - in both lakes; Al, Cu, K, Sb, Sr and Pb in either lake), reaching 1370 µg/L Cu, 4610 µg/L Mn, and 687 µg/L Zn in the bottom water layers. Permafrost-related waters were also enriched in dissolved phosphorus (up to 512 µg/L in Yedoma-fed creeks). The impact of permafrost thaw on river and lake water chemistry is a complex problem which needs to be considered both in the context of legacy permafrost shrinkage and the interference of the deepening active layer with newly deposited anthropogenic contaminants.

It is a consensus in academia and the industry that 2D Digital Image Correlation (2D-DIC) is inferior to a stereo DIC for high-accuracy material testing applications. It has been theoretically established by previous researchers that the 2D-DIC measurements are prone to errors due to the inability of the technique to capture the out-of-plane motion/rotation and the calibration errors due to lens distortion. Despite these flaws, 2D-DIC is still widely used in several applications involving high accuracy and precision, for example-studying the fracture behavior of sheet metal alloys. It is, therefore, necessary to understand and quantify the measurement errors induced in the 2D-DIC measurements. In this light, the presented work attempts to evaluate the effectiveness of 2D-DIC in mechanical testing required for the generation of fracture strain vs. triaxiality curve for sheet metal. This work presents a direct comparison of fracture strains obtained by 2D-DIC and stereo DIC for four loading conditions (uniaxial tension, plane strain, shear, and balanced biaxial tension) on two materials with very diverse mechanical and fracture properties-CR4 and DP800 steel. The comparisons are done for full-field strain contours, fracture strains and strain paths/triaxialities generated using the two DIC systems. A simple technique is proposed to compensate for the effects of out-of-plane motion in the 2D measurements. It is shown that 2D-DIC can capture the material deformation with sufficient accuracy not only for planar specimens but also for certain scenarios involving out-of-plane motion (like balanced biaxial tension) by theoretical compensation of the strains. KEYWORDS Digital Image Correlation, full-field strain, optical metrology, fracture strain, Advanced high-strength steel 2

Objective: To investigate post-intubation laryngeal complications in severe COVID-19 patients. Methods: From September 2020 to April 2021, consecutive patients presenting with laryngological symptoms following severe COVID-19 infection and related intubation were included. Demographic, age, gender, comorbidities, symptoms, intubation duration, tracheostomy features, and laryngeal findings were collected. Videolaryngostroboscopy findings were analyzed by two senior laryngologists in a blind manner. Results: Forty-three patients completed the evaluations. The intubation duration was <14 days in 22 patients (group 1) and >14 days in 21 patients (group 2). The following abnormalities were found on an average post-intubation time of 51.6 days: posterior glottic stenosis (N=14), posterior commissure hypertrophy (N=19) or laryngeal diffuse edema (N=10), granuloma (N=8), laryngeal necrosis (N=2), vocal fold atrophy (N=2), subglottic stenosis (N=1) and glottic flange (N=1). Sixteen patients required surgical treatment (N=17 procedures). The number of intubation days was significantly higher in patients with posterior glottic stenosis (26.1 ± 9.4) compared with those presenting posterior commissure hypertrophy (11.5 ± 2.9) or granuloma (15.1 ± 5.8; p<0.001). Fourteen patients required surgical management. Conclusion: Prolonged intubation used in severe COVID-19 patients is associated with significant laryngeal disorders. Patients with a history of >2-week intubation have a higher risk of posterior glottic stenosis.

Plant species bearing extrafloral nectaries (EFNs) may indirectly influence other plant species by sharing protective ants, potentially altering plant herbivory levels. However, the propagation of indirect effects in this type of mutualism has seldom been investigated. We investigated indirect effects via ant sharing among twenty-one EFN-bearing plant species of the tribe Bignonieae distributed on 28 plots in the central Brazilian Amazon. Using an ecological network index that quantifies potential indirect effects among plant species via ant sharing, we distinguished plant species that could most strongly affect and most strongly be affected by other species via shared dominant and subordinate ant species. These Bignonieae species differ markedly in attractiveness to ants, and we investigated how these differences influenced the indirect effects between plant species. We also tested whether plant species with a higher potential to influence ant visitation to other plants experienced less herbivory due to attraction of more aggressive/dominant ants. We found that the most attractive plant species (here termed the promoter species) had the highest potential to indirectly affect ant visitation to less attractive plant species (here termed the receptor species) in the community, mainly via changes in attraction of dominant ant species. However, the potential indirect effects among plants did not translate into herbivory patterns. We also found that ant attendance and herbivory did not differ among promoter species, their neighbours, and non-neighbouring plants. We conclude that, unlike patterns found in studies investigating indirect effects in other mutualisms involving plants (e.g., pollination), the consequences of indirect effects among plant species are limited in this ant-plant network. This pattern could be explained by generally low herbivory levels and the small foraging areas of shared ant defenders. Indirect interactions and their effects between plant species that share protective ants appear in this system to confer limited costs and benefits.

Like many top consumers, parasites can regulate feeding of their prey via trait-mediated means. If parasites modify the feeding behavior of ecologically important grazers, they may have cascading effects on the structure and functioning of whole plant communities. The extent to which parasites can influence plant communities in this way is largely dependent on the strength of their behavioral alteration, their prevalence in host grazers, and the density of those hosts. Recent experiments and comparative surveys in southeastern USA salt marshes revealed that common larval trematode parasites suppress the per capita grazing impacts of the marsh periwinkle (Littoraria irrorata), generating a trophic cascade that protects foundational marsh plants from drought-associated overgrazing. Here, we conducted a field manipulation wherein we modified grazer host density while holding infection prevalence constant at an ecologically relevant level (20%) to determine whether the indirect, facilitative effects of parasites on marsh plants varied with the density of grazers. We found that parasites had significant positive impacts on marsh net primary productivity at moderate densities of snails (≥50 snails/ 0.5 m2), but that the positive effects of parasites were negligible at lower densities. Our results confirm the findings of previous studies that parasites can protect marsh plants from overgrazing at sufficiently high prevalence, but show that their ability to do so depends on host density.

Objective To build a clinical prediction models (CPMs) for severe CRF of cervical cancer (CC) patients, and conduct online 8-week mindfulness-based stress reduction (MBSR). Design Single-centre, cross-sectional, randomized controlled trial. Setting Gynecological clinic of a tertiary hospital in Shenyang. Population 284 patients, and 100 patients with severe CRF included in randomized controlled trial. Methods Patients were divided into construction group and validation group to verify the accuracy of CPMs. All patients participated in online 8-week MBSR and were followed up for 3 and 6 months. Main outcome measures The primary outcome were the accuracy of the CPMs and effectiveness of MBSR on CRF at 6 month. Secondary outcomes included the influencing factors of CRF, effectiveness of MBSR on sense of coherence, coping style, and perceived social support. Results In the CPMs: the C-Index was 0.921; the sensitivity was 0.821; the specificity was 0.900; the accuracy was 0.857; the AUC was 0.916; the area under the ROC curve was greater than 0.8; the calibration curve fitted well (P<0.05); and the net benefit of applying the model to most thresholds was good in DCA. At 6 months, CRF was from 37.70 to 31.25; SOC was from 55.07 to 64.17; ways to face was from 19.20 to 20.95; and ways to yield was from 12.10 to 8.90 in MBSR group (P<0.01). Conclusion The CPMs could be used as a prediction and evaluation tool for severe CRF, and the online 8-week MBSR can effectively improve the CRF of CC patients.