Lineage-based species definitions applying coalescent approaches to species delimitation have become increasingly popular. Yet, the application of these methods and the recognition of lineage-only definitions have recently been questioned. Species delimitation criteria that explicitly consider both lineages and evidence for ecological ‘role’ shifts provide an opportunity to incorporate ecologically meaningful data from multiple sources in studies of species boundaries. Here, such criteria were applied to a problematic group of mycoheterotrophic orchids, the Corallorhiza striata complex, analyzing genomic, morphological, phenological, reproductive-mode, niche, and fungal host data. A recently developed method for generating genomic polymorphism data–ISSRseq–demonstrates evidence for four distinct lineages, including a previously unidentified lineage in the Coast Ranges and Cascades of California and Oregon, USA. There is divergence in morphology, phenology, reproductive mode, and fungal associates among the four lineages. Integrative analyses, conducted in population assignment and redundancy analysis frameworks, provide evidence of distinct genomic lineages and a similar pattern of divergence in the ‘extended’ data, albeit with weaker signal. However, none of the ‘extended’ datasets fully satisfy the condition of a significant ‘role’ shift, which requires evidence of fixed differences. The four lineages identified in the current study are recognized at the level of variety, short of comprising different species. This study represents the most comprehensive application of ‘lineage+role’ to date and illustrates the advantages of such an approach.

The non-pharmacological measures to contain the COVID-19 pandemic implemented in 2020 significantly impacted child admissions for respiratory diseases. This study aims to evaluate the impact of these measures on the incidence of child admissions after the resumption of school activities. Methods: This is a longitudinal study, conducted by analyzing pediatric hospital admissions data. It included data on patients diagnosed with bronchiolitis, asthma, or pneumonia. The period studied was from January to July of 2019, 2020, and 2021. Poisson regression models with robust variance were used to obtain relative risk and the respective 95% CI. For statistical significance, p <0.05 was used. Results: A total of 4024 pediatric admissions due to the diseases covered were recorded during the period studied. The reduction in admissions and costs in 2021 compared with 2019 was 56.99 admissions/100,000 children and 56% lower, respectively. Conclusion: Even during the period of relaxation of the non-pharmacological measures to contain the COVID-19 pandemic, there was a significant and clinically important reduction in the number of admissions due to respiratory diseases in children. The maintenance of the reduction in admissions indicates that these measures can have a highly important impact on infant health even after the resumption of school activities.

A 77-year-old woman with palpitations was referred for a second radiofrequency ablation for persistent atrial tachycardia (AT). She previously underwent pulmonary vein (PV) isolation for paroxysmal atrial fibrillation, linear ablation between the 3’o clock position of the mitral annulus (MA) and left PV from the endocardium, and ablation inside the coronary sinus (CS) for perimitral atrial tachycardia (PMAT) in the first procedure. A baseline 12-lead electrocardiogram in the second procedure showed stable AT with a cycle length (CL) of 250 ms. No PV reconnection was observed. The CS catheter was placed from 3:30 to 5:00 on the MA, and a proximal-to-distal pattern of CS activation during AT was observed. Activation mapping in the left atrial (LA) endocardium using a three-dimensional mapping system (CARTO3, Biosense Webster, Diamond Bar, CA, USA) revealed a sequence of counterclockwise rotations of the MA. Figures 1A and 1B show the intracardiac electrograms during high-output (20 V) and low-output (5 V) atrial entrainment pacing at a pacing CL of 240ms from CS 3,4, which corresponds to the 4’o clock position of the MA. Dose residual conduction occur across the mitral isthmus (MI) endocardium, epicardium, or both? What is the electrophysiological mechanism during high- and low-output entrainment pacing?

Objective: To study the impact of shoulder dystocia (SD) simulation training on the SD management and the incidence of permanent brachial plexus birth injury (BPBI). Design: Retrospective observational study Setting: Helsinki University Women’s Hospital, Finland Sample: Deliveries with SD Methods: Multi-professional, regular and systematic simulation training for obstetric emergencies began in 2015 and SD was one of the main themes. A study was conducted to assess changes in SD management and the incidence of permanent BPBI. The study period was from 2010 to 2019; years 2010–2014 were considered the pre-training period and 2015–2019 the post-training period. Main outcome measures: The primary outcome measure was the incidence of permanent BPBI after the implementation of systematic simulation training. Also changes in the SD management were analysed. Results: During the study period, 113,085 vertex deliveries were recorded. The incidence of major SD risk factors (gestational diabetes, induction of labour, vacuum extraction) increased and was significantly higher for each of these (p <0.001) during the post-training period. The incidence of SD also increased significantly (0.01 vs 0.3%, p <0.001) during the study period, but the number of children with permanent BPBI decreased dramatically after the implementation of systematic simulation training (0.04 vs 0.02%, p <0.001). The most significant change in the management of SD was increased incidence of a successful delivery of the posterior arm. Conclusions: Systematic simulation-based training of midwives and doctors can translate into an improved individual and team performance and significantly reduce the incidence of permanent BPBI.

Surface pattern is a promising approach to enhance membrane performance while contradictory results have been reported on concentration polarization of patterned membranes. Here, we provide an experimental and modeling study of the concentration polarization on patterned membranes by varying pattern size, solute size, surface hydrophilicity and membrane orientation. Interesting trends were observed when comparing different membrane orientation, where relative concentration polarization degree (CPD) was found to be dependent on molecular weight. Salts and small organic molecules encountered more severe CPD in the transverse mode, while molecules larger than a threshold value showed a different trend. Such threshold molecular weight increased at larger pattern size. Simulation results were consistent with experimental observations, and revealed the critical role of diffusivity on such phenomena. Results also showed more severe concentration polarization on patterned membranes in both parallel and transverse modes in most cases, compared to smooth membrane.

Unrepaired secundum ASD (atrial septal defect) is the commonest congenital heart disease encountered in adulthood. In this study we try to correlate the three-dimensional size of a secundum ASD to the device size. We did a retrospective analysis to 36 patients who underwent successful transcatheter closure of atrial septal defect guided by balloon sizing and correlated this to the device size. The device size was correlated significantly with all the maximal ASD diameter by 2D-TTE, 2D-TEE and 3D-TEE. However, the most significant correlation was between three-dimensional maximal diameter and device. 3D TEE is a promising and reliable tool that can be used to determine the size, number and shape of ASD and to accurately select the suitable device size during percutaneous closure.

Attribution analysis of changes in evapotranspiration ( ET ) is important for understanding the mechanisms that control ET , which is necessary for reliable modeling and predicting. In this study, we combined eddy covariance methods with the Shuttleworth-Wallace (SW) model to assess the relative contributions of climate and vegetation variables to soil evaporation ( ) and plant transpiration ( ) for an area of maize at Daman Station, and an area of grassland at Arou Station. We quantitatively evaluated the contribution of different potential drivers using partial-differential equations, and found that the available energy at the soil surface and the saturation vapor pressure deficit had the strongest influence on . Although less significant that climate factors, vegetation factors, such as stomatal conductance, had an important impact on for maize and grass. Our results show that changes in the canopy resistance make the biggest contribution to change. Our sensitivity analysis indicates that is most sensitive to aerodynamic resistances from the soil surface to canopy height, and that is most sensitive to surface resistance for the plant canopy, and less sensitive to aerodynamic resistances from the leaf to canopy height. Our study shows that changes in ET were influenced by complex interactions between climate and vegetation variables, and the main drivers for changes in ET were different in different months.

An eight-year-old girl with cystic fibrosis (CF) developed a left upper lobe collapse failing to resolve with initial conventional antibiotic treatment, mucolytics and intensified physiotherapy. Mycobacterium abscessus was isolated from her sputum. Bronchoscopy revealed thick viscous mucus plugging of the left upper lobe bronchus with complete obliteration. Three bronchoscopies with saline lavage and Dornase alfa, a rhDNase, at the end of each procedure resulted in removal of this mucus plug and the re-inflation of the affected lobe, with clinical and radiological resolution. The use of flexible bronchoscopy as a ‘secondary’ treatment with 0.9% saline lavage and instillation of rhDNase is described sparsely in the literature. This is the first reported successful therapeutic resolution of a lung collapse in a CF patient with Mycobacterium abscessus, with sequential therapeutic bronchoscopies with instillation of Dornase alfa. This should be considered for lobar collapse in CF not responding to the standard therapeutic regime.

We propose a new type of non-polynomial fractional spline function with fractional continuity conditions for integral equations. The Caputo fractional derivative was used to generate fractional spline derivatives. Moreover, the convergence analysis was investigated. The approach is also well discussed and supported with computational numerical results, with the results indicating that it is both accurate and simple to implement.

A document by Awol Yemane. Click on the document to view its contents.

In this paper, we discuss the Turing-Hopf bifurcation of a diffusive Holling-Tanner model with nonlocal effect and digestion time delay. The stability, Turing bifurcation, Hopf bifurcation and Turing-Hopf bifurcation are first researched. Then we derive the algorithm for calculating the normal form of Turing-Hopf bifurcation of a diffusive Holling-Tanner model with nonlocal effect and digestion time delay. At last, we carry out some numerical simulations to verify our theoretical analysis results. The stable positive constant steady state and the stable spatially inhomogeneous periodic solutions are found. Furthermore, the evolution process from unstable spatially inhomogeneous steady states to stable positive constant steady state, the evolution process from unstable spatially inhomogeneous steady states to stable spatially inhomogeneous periodic solutions, the evolution process from one unstable spatially inhomogeneous periodic solution to another stable spatially inhomogeneous periodic solution and the evolution process from unstable spatially inhomogeneous periodic solution to stable positive constant steady state are also found.

Aorto-tracheal fistulas are rare and highly lethal, with few reports of successful surgical intervention. We present a 48 year old man with aorto-tracheal fistula induced by radiation therapy for tracheal squamous cell carcinoma. He presented with hemoptysis and chest pain and workup revealed the aorta-tracheal fistula between the posterior aortic arch and anterior distal trachea. He was emergently taken to surgery. To our knowledge, this is the first report of an aorto-tracheal fistula successfully treated with a transverse aortic arch replacement and complex tracheal repair using autologous pericardium with an omental buttress.

Allergy tests for the diagnosis of culprit allergens in eosinophilic esophagitis: A systematic review. To the Editor,Eosinophilic esophagitis (EoE) is a chronic inflammatory disease with esophageal dysfunction and marked eosinophil-predominant infiltration of the esophagus and a clinicopathologic diagnosis (1,2). Dietary interventions have confirmed the etiological role of food allergens and their combination with topical glucocorticoids is the standard treatment of EoE (1). Three different dietary approaches are usually practiced; an elemental formula diet, “empiric” food eliminations diets (e.g. the 6-FED) and diets based on multimodality allergy testing(1). Skin prick tests (SPT), serum specific (s)IgE, atopy patch tests (APT), but also serum specific (s)IgG4 have been used as allergy diagnostic tools for such diets(1).Elimination diets can serve as the first step to identify the culprit antigens in EoE; after symptoms’ remission foods can be sequentially reintroduced and food triggers can be defined clinicopathologically (1,2). In the present systematic review, the outcomes of a food-reintroduction diagnostic approach served as comparator to the results of allergy tests serving as diagnostic tools of the EoE food triggers. Our aim was to review the literature on the diagnostic value of allergy tests used in everyday practice.The detailed methods of the present systematic review are reported in the published protocol (3). The evidence search and selection process are presented in Figure 1. Fourteen studies fulfilling the quality assessment criteria were included in the review; their characteristics are summarized in Table 1 (references in the supplement). The Risk-of-Bias ratings are shown in Table S1. The studies were assessing complete data of 453 EoE patients. Biopsies were used for re-evaluation in all studies, and as the main criterion of EoE remission in most of the studies.The positive predictive value (PPV) of allergy tests is reported in Table S2. It is deduced by the percentage of allergy tests that have correctly predicted the culprit allergen out of the total number of allergy tests resulting positive. The percentage of patients who responded to treatment was calculated by dividing the number of patients who presented EoE remission after food elimination diets based on positive allergy tests, out of the total number of patients following such diets. Reviewed studies have offered either, or both, of these data.Studies have followed a protocol with a single allergy test, or with the combination of two (SPT+sIgE, SPT+APT), or three. Most single-allergy-test studies have reported PPVs lower than 50%. PPV was better for combined tests; PPV of SPT+APT combination was 67.1%, with 65-88.3% of patients presenting symptom amelioration after following a relevant elimination diet. A study combining SPT+APT+sIgE reported symptoms’ improvement in 67% of the patients.The effectiveness of amino-acid-based elemental diet is approximately 90%, while 6-FED shows a 72.1% effectiveness (4) . The empiric elimination of cow’s milk or dairies is a slightly less-effective strategy. According to our review’s outcomes, allergy-test-driven elimination diets have a maximum efficacy of 66-88.3%, so following them is not superior to empirical diets. The decision to follow any of these options, or alternatively a 4-FED or 2-FED, is individualized according to what best fits to patient’s lifestyle.Esophageal prick testing (EPT) performed with food extracts directly on the esophageal lining is a new diagnostic method offering the advantage to examine the local esophageal response to dietary triggers, that might be completely different to IgE-detection with the usual allergy tests (5). Ex vivo food antigen stimulation method, using stimulation of esophageal biopsies with food extracts is another promising alternative (6).Concluding, although the use of food specific IgE-detection and the performance of APT do not seem useful for selecting which food should be eliminated, it is a fact that personalized elimination of different foods in each patient is highly advised.

Abstract Since the COVID-19 outbreak in late 2018, growing evidence supported the association between COVID-19 infection & hypercoagulability. We report an interesting case of a right atrial thrombus in a young female who sustained COVID-19 infection few months before this diagnosis, as a result she required an open-heart surgery to extract the thrombus. Introduction Mobile atrial thrombi are rare to occur with few reported cases in literature, since COVID has masked the face of the universe with a completely new disease entity with multiple systemic affection, has also been strongly linked with prothrombotic state, However, only very few counted cases of atrial thrombi have been linked to COVID-19 infection.

methamphetamine (MA) has a similar structure to amphetamine which can induce a wide range of symptoms, including alertness, aggressive behavior, chest pain, psychosis, seizures, developed by the psychomotor system stimulation. This case specifically discusses prolonged severe MA intoxication induced by a novel and unique way of the drug’s ingestion.

NUT carcinoma clinical feature as rare, high lethal, and fast development, easy misdiagnose, and no effective therapy, and have a depressed prognosis. We explore the best strategy about the pulmonary nut carcinoma by analyze our case and retrospective study a lots of others case reports clinical features and therapies

Environmental temperature is a key driver of malaria transmission dynamics. Using detailed temperature records from four sites (1800-3200m) in the western Himalaya, we model how temperature regulates parasite development rate (the inverse of the extrinsic incubation period, EIP) in the wild. Using a Briére parametrization of the EIP, combined with Bayesian parameter inference, we study the thermal limits of transmission for avian (P. relictum) and human Plasmodium parasites (P. vivax and P. falciparum) as well as for two malaria-like avian parasites, Haemoproteus and Leucocytozoon. We demonstrate that temperature conditions can substantially alter the incubation period of parasites at high elevation sites (2600-3200m) leading to restricted parasite development or long transmission windows. We then compare estimates of EIP based on measures of mean temperature versus hourly temperatures to show that EIP days vary in cold versus warm environments. We found that human Plasmodium parasites experience a limited transmission window at 2600m. In contrast, for avian Plasmodium transmission was not possible between September to March at 2600m. In addition, temperature conditions suitable for both Haemoproteus and Leucocytozoon transmission were obtained from June to August and in April, at 2600m. Finally, we use temperature projections from a suite of climate models to predict that by 2040, high elevation sites (~ 2600 m) will have a temperature range conducive for malaria transmission, albeit with a limited transmission window. Our study highlights the importance of accounting for fine-scale thermal effects in the expansion of the range of the malaria parasite with global climate change.

Aims: It is known that the angle between the aorta and the septum on the long axis in two-dimensional echocardiography is different between individuals in the community. The relationship between aortoseptal angle (AoSA), age and diastolic dysfunction has been mentioned in a couple of articles. We aimed to investigate if this angle is directly related to duration of hypertension (HT), regardless of age factor. Method: The data of 1294 patients who applied to the cardiology outpatient clinic and whose AoSAs were recorded and analyzed retrospectively. SPSS 20 was entered and the correlation of AoSA with age, duration of HT and other data was investigated. Results: A significant correlation was found between AoSA, duration of HT, age, and diameter of the ascending aorta. A partial correlation was sought for when age was taken under control, and then a significant correlation was found between AoSA, duration of HT and diameter of the ascending aorta. Conclusion: Aorta is known to lengthen depending on age and duration of HT. This elongation shows that the aortic root, the free end of the aorta, is progressing towards the ventricle. This situation narrows the angle between the septum and aorta. As a result, one can have an idea about how long patients have hypertension by looking at the narrowing in AoSA.

Let $H_c$ be a $(2n)\times(2n)$ symmetric tridiagonal matrix with diagonal elements $c \in \mathbb{R}$ and off-diagonal elements one, and $S$ be a $(2n)\times(2n)$ diagonal matrix with the first $n$ diagonal elements being plus ones and the last $n$ being minus ones. Davies and Levitin studied the eigenvalues of a linear pencil $\mathcal{A}_c=H_c-\lambda S$ as $2n$ approaches to infinity. It was conjectured by DL that for any $n \in \mathbb{N}$ the non-real eigenvalues $\lambda$ of $\mathcal{A}_c$ satisfy both $|\lambda + c|<2$ and $|\lambda - c|<2$. The conjecture has been verified numerically for a wide range of $n$ and $c$, but so far the full proof is missing. The purpose of the paper is to support this conjecture with a partial proof and several numerical experiments which allow to get some insight in the behaviour of the non-real eigenvalues of $\mathcal{A}_c$. We provide a proof of the conjecture for $n \leq 3$, and also in the case where $|\lambda + c|=|\lambda - c|$. In addition, numerics indicate that some phenomena may occur for more general linear pencils.

Livestock rearing and agriculture are the main sources of communities to sustain livelihood in the developing country like middle-mountain of the Nepal. Leopard is a top predator in habitat of mid-hill which is a major conflict wild animal. Forest degradation and declining wild prey population bring leopard to conflict. The spatial and temporal patterns of human-wildlife conflicts are poorly documented at provincial and national level that hinders in formulating effective conflict mitigation plan at real field. To assess pattern of human-leopard conflict (HLC) at spatial and temporal scale, primary data was collected through registered human wildlife conflict case collection which were triangulated through interview with victim(n=156) and we used maximum entropy along with relevant predictor variables to predict and map HLC risk area at provincial level. The cases of HLC are increasing trend last the five years. Annual average of 2.16 human death which shows increasing trend (p<0.05), 5.16 human injury which shows decreasing trend (p>0.05) and annual average of 159.6 livestock depredation which shows increasing trend (p<0.05) were recorded in last five years. Winter is a main season of depredation and goat was main depredated livestock. Out of total US$ 86892.25 ($17378.45/year) economic loss, 78.57% was paid as relief indicating implementation of government’s relief fund of human-wild conflict. Results revealed mid elevated southern facing areas are more prone to HLC with an ecological variable mean annual temperature as top predictor including livestock density and distance to road. Predator-proof livestock corrals, educating local communities about wildlife behavior and timely management of problem animals will contribute to reduce the conflict.

Cardiorespiratory monitoring is recommended for the assessment of symptomatic preterm newborns and infants with a clinical history of Apparent Life-Threatening Events (ALTE). Patients who experience cardiorespiratory events usually have to be moved to specialized centers to perform cardiorespiratory studies. To avoid the transfer of these patients to specialized centers, it has been created a network based on an interchange system where the recordings were uploaded in unspecialized centers (spokes) and downloaded by the Sleep Disorders Breathing (SDB) Center (hub) to be analyzed. From November 2008 to December 2020 cardiorespiratory recordings belonging to 422 patients were collected. This study shows that the inter-hospital network is an efficient system that allows accurate and safe management of infants at risk of apnoea, bradycardia, and hypoxemia also in unspecialized centers, avoiding unnecessary transfers of patients and over – hospitalizations.

Title: Evaluation of Basophil Activation Tests to Diagnose Tolerance to Food Allergens Erik N. Newman, MDa,b, Patricia Merkel, MSc, Leah Huey, BSc, Maureen Bauer, MDc, Matthew Greenhawt, MD, MBA, MScc, Vijaya Knight MD, PhDcaDepartment of Dermatology, University of Utah School of MedicinebDivision of Allergy & Immunology, Department of Pediatrics, University of Utah School of MedicinecDepartment of Pediatrics, Section of Allergy and Immunology, Children’s Hospital Colorado, University of Colorado School of MedicineSource of Funding: University of Colorado Department of Pediatrics and Children’s Hospital Colorado Research InstituteDisclosure: Matthew Greenhawt is supported by grant #5K08HS024599-02 from the Agency for Healthcare Research and Quality; is an expert panel and coordinating committee member of the NIAID-sponsored Guidelines for Peanut Allergy Prevention; has served as a consultant for the Canadian Transportation Agency, Thermo Fisher, Intrommune, and Aimmune Therapeutics; is a member of physician/medical advisory boards for Aimmune Therapeutics, DBV Technologies, Sanofi/Genzyme, Genentech, GlaxoSmith Kline, Merck, Nutricia, Kaleo Pharmaceutical, Nestle, Aquestive, Allergy Therapeutics, AllerGenis, Aravax, and Monsanto; is a member of the scientific advisory council for the National Peanut Board; has received honorarium for lectures from Thermo Fisher, Aimmune Therapeutics, DBV Technologies, Before Brands, multiple state allergy societies, the American College of Allergy Asthma and Immunology, the European Academy of Allergy and Clinical Immunology; is an associate editor for the Annals of Allergy, Asthma, and Immunology; and is a member of the Joint Taskforce on Allergy PracticeWORD COUNT: 1149Key words: basophil activation test, food allergy, diagnostic testing

Grey seals (Halichoerus grypus) can act as sentinel species reflecting the condition of the environment they inhabit. Our previous research identified strains of pathogenic Campylobacter and Salmonella, originating from both human and agricultural animal hosts, on rectal swabs from live grey seal (Halichoerus grypus) pups and yearlings on the Isle of May, Scotland, UK. We examined rectal swabs from the same pup (n=90) and yearling (n=19) grey seals to gain further understanding into the effects of age-related changes (pup versus yearling) and three different natal terrestrial habitats on seal pup fecal microbiota. DNA was extracted from a subset of rectal swabs (pups n=23, yearlings n=9) using an optimized procedure, and the V4 region of the 16S rRNA gene was sequenced to identify each individual’s microbiota. Diversity in pup samples was lower (3.92 ± 0.19) than yearlings (4.66 ± 0.39) although not significant at the p=0.05 level (p = 0.062) but differences in the composition of the microbiota were (p < 0.001). Similarly, differences between the composition of the microbiota from pups from three different terrestrial habitats (PH, RR, and TS) were highly significant (p < 0.001). Pairwise tests showed significant differences between all three habitats: PH vs TS (p = 0.019), PH vs RR (p = 0.042) and TS vs RR (p = 0.020). This preliminary study suggests a general trend, that seal microbiomes are modified by both age and, in pups, different terrestrial habitats. Furthermore, knowledge of the microbiota species present has the potential to be used in determining the environmental quality index.

Host-specialist parasites of endangered large vertebrates are in many cases more endangered than their hosts. In particular, low population densities and reduced among-host transmission rates are expected to lead to inbreeding within parasite infrapopulations living on single host individuals. Furthermore, spatial population structures of directly-transmitted parasites should be concordant with those of their hosts. Using population genomic approaches, we investigated inbreeding and population structure in a host-specialist seal louse (Echinophthirius horridus) infesting the Saimaa ringed seal (Phoca hispida saimensis), which is endemic to Lake Saimaa in Finland, and is one of the most endangered pinnipeds in the world. We conducted genome resequencing of pairs of lice collected from 18 individual Saimaa ringed seals throughout the Lake Saimaa complex. Our analyses showed high genetic similarity and inbreeding between lice inhabiting the same individual seal host, indicating low among-host transmission rates. Across the lake, genetic differentiation among individual lice was correlated with their geographic distance, and assignment analyses revealed a marked break in the genetic variation of the lice in the middle of the lake, indicating substantial population structure. These findings indicate that movements of Saimaa ringed seals across the main breeding areas of the fragmented Lake Saimaa complex may in fact be more restricted than suggested by previous population-genetic analyses of the seals themselves.