Successful prevention of epidemics depends on vaccine compliance and the resultant maintenance of high vaccination coverage for long periods. However, to the best of our knowledge, a study of the temporal dynamics of compliance in voluntary vaccination campaigns and of the factors which influence them was never published. In this study, we investigated the factors influencing the dynamics of vaccination compliance against lumpy skin disease (LSD) after the occurrence of LSD epidemics in Israel in 2012-2013 and 2019. From 2016 to 2019, we followed voluntary LSD annual vaccination among a cohort of 566 farmers and used questionnaires based on the theory of planned behaviour to investigate the incentives influencing vaccine compliance among 90 farmers. The results showed a reduction in vaccination against LSD from 61% in 2016 to 27% in 2019 and a very strong association between prior vaccination and vaccination compliance. The actual vaccination by farmers who stated a positive intention to vaccinate was 4.5 times higher than farmers who did not (p-value=0.007). However, half of the highly intended farmers eventually didn’t vaccinate their herd. These farmers were significantly more concerned by manpower and vaccine price compared to their vaccinating counterparts, pointing to vaccination effort perceptions as a major factor influencing compliance. In addition, we found that farmers who answered the questionnaires before the epidemic of 2019 perceived significantly less pressure to vaccinate imposed by veterinary organizations (private and governmental) than farmers answering them during or after the epidemic. We conclude that the veterinarian-associated social pressure is a major compliance-enhancing factor, influenced by the occurrence of an epidemic. Our findings suggest that the deterioration of vaccination compliance after an epidemic can be mitigated by maintenance of pressure to vaccinate by veterinarians. Manpower support and vaccine discounts may be advocated to promote vaccine compliance.

Planting Robinia pseudoacacia in water-limited regions can promote soil and water conservation and improve ecological service function. However, it can also cause the formation of below-ground dried soil layers (DSLs), causing land degradation and tree mortality. To ascertain the spatial-temporal dynamics and recovery processes of DSLs, we monitored the deep soil water content (SWC) to a depth of 500 cm at 27 sites on a typical R. pseudoacacia forest (planted in 2003) hillslope from 2017–2020, and calculated the evaluation indices of DSLs based on plant and soil criteria. We found that, compared to plant criterion identified-DSLs, the degree of soil criterion identified-DSLs was more severe, although the spatial-temporal characteristics were similar. Severe soil desiccation was identified in the forest as 79% of the 500 cm profile drying out below 101 cm. During the study period, the mean thickness of DSLs and mean SWC within DSLs were 397 cm and 9.0%, respectively, and the quantitative index of DSLs reached level III (> 0.51, severe DSLs). All DSL indices demonstrated weak or moderate variability in space and strong variability in time. Interestingly, two rainfall events triggered DSL disappearance at seven sites, indicating the possibility of DSL recovery under heavy rainfall. Possible mechanisms explaining the DSLs recovery phenomenon were linked with continued rainfall, micro-topography, soil texture, individual root characteristics, and their interactions. This information is helpful for soil water management and land development in planted forests and for reclaiming DSLs under similar conditions.

Graph representation learning has attracted increasing attention in a variety of applications that involve learning on non-Euclidean data. Recently, generative adversarial networks(GAN) have been increasingly applied to the field of graph representation learning, and large progress has been made. However, most GAN-based graph representation learning methods use adversarial learning strategies directly on the update of the vector representation instead of the embedding mechanism, which does not make full use of the essential advantages of GAN. The essential advantage of GAN is the final embedding mechanism rather than the embedding representation itself. To address this problem, we propose to use adversarial idea on the reconstruction mechanism of deep autoencoders. Specifically, the generator and the discriminator are the two basic components of the GAN structure. We use the deep autoencoder as the discriminator, which can capture the highly non-linear structure of the graph. In addition, the generator another generative model is introduced into the adversarial learning system as a competitor. A series of empirical results proved the effectiveness of the new approach.

Objective To assess whether the subendometrial blood flow condition detected by Doppler ultrasound could predict pregnancy outcomes in patients with thin endometrium during in vitro fertilization (IVF) treatment. Design Retrospective cohort study. Setting Reproductive Hospital affiliated with Shandong University, Jinan, Shandong, China Population or Sample The study included 3830 frozen embryo transfer (FET) cycles of 3,830 IVF patients between January 2017 to December 2019. Methods Endometrial thickness, endometrial blood flow, and subendometrial blood flow were measured using transvaginal color Doppler ultrasound, evaluated by experienced clinical ultrasound physicians on the day of endometrial transformation. Logistic binary regression was used to analyze the effects of subendometrial blood flow on successful embryo implantation. Pregnancy outcomes of these patients were documented in clinic medical records during follow-up. Main Outcome Measures Pregnancy outcomes (biochemical pregnancy rate, clinical pregnancy rate and live birth rate) Results A total of 3830 frozen embryo transfer cycles were retrospectively analyzed. Our results show that patients with subendometrial blood flow exhibit higher average success rates of live birth, clinical pregnancy, and embryo implantation compared to those without subendometrial blood flow when endometrial thickness is ≤ 0.7 cm. In detail, in thin endometrium patient group, the presence of subendometrial blood flow is correlated with 7.2% higher biochemical pregnancy rate, 7.0% higher clinical pregnancy rate, and 6.2% higher live birth rate compared to those without subendometrial blood flow. Conclusions Endometrial and subendometrial blood flow conditions have predictive value for pregnancy outcomes after frozen embryo transfer in patients with thin endometrium

The optimization of crashworthiness in aerospace and automotive industries is one of the key research targets of the leading respective industries. In the past few decades; the use of composites in structural applications has been increasingly used in aerospace and advanced transportation industries because of their excellent mechanical properties and better strength-to-weight ratio than metal. In this paper composite materials constituent and their application in aerospace industry and their failure modes has been presented. The effects of the impact damage on the carbon fiber composites as the one of the most common materials in the aerospace industry has been investigated and evaluated by using non-destructive testing methods. This review considered the capabilities of the most common methods of NDT in composite materials. Damage modes interaction, types of velocity, and influence of various factors on impact behavior was investigated and must be considered to predict any failure in composite materials.

Background: Manual percussion is used during airway clearance sessions for children with cystic fibrosis. Use of percussor cups can assist manual chest physiotherapy percussion when the treatment is too taxing, or the adult hand is too large. The Canadian distribution for the usual commercial percussor was recently discontinued. The McMaster Manufacturing Research Institute (MMRI) was approached to produce two percussor cup prototypes as potential alternatives. The objective of this study was to evaluate the useability, satisfaction, preference, and safety of the MMRI percussor cups compared to the Smiths Palm Cup® Percussor. Methods: Participants were allocated to two groups based on age. Order of percussor cup use was randomized; caregivers used each percussor cup for 2 consecutive days. Data collection included: demographics, the Quebec User Evaluation of Satisfaction with assistive Technology 2.0, the Pictorial Single-Item Usability Scale, adverse effect report, overall satisfaction ratings and top percussor cup ranking. Results: Twenty-five caregivers and their children enrolled in and completed the study. The MMRI narrow handle percussor prototype, regardless of cup size, was comparable in usability, safety and effectiveness. This can be a locally sourced, innovative solution in Canada for a pediatric percussor cup. Conclusions: All percussor types were favourably reported across metrics examining usability, safety, and effectiveness, apart from the MMRI small cup, wide handle prototype. Overall, the MMRI wide handle prototype was the least preferred, regardless of cup size, while the MMRI narrow handle prototype was comparable to the Smiths Palm Cup® Percussor across all metrics, regardless of cup size.

Letter to Editor:

Background: Initial clinical evaluation (ICE) is traditionally considered a useful screening tool to identify frail patients during the pre-operative assessment. However, emerging evidence supports the more objective assessment of cardiorespiratory fitness (CRF) via cardiopulmonary exercise testing (CPET) to improve surgical risk stratification. Herein, we compared both subjective and objective assessment approaches to highlight the interpretive idiosyncrasies. Methods: As part of routine pre-operative patient contact, patients scheduled for major surgery were prospectively ‘eyeballed’ (ICE) by two experienced clinicians prior to more detailed history taking that also included American Society of Anaesthesiologists score classification. Each patient was subjectively judged to be either ‘frail’ or ‘not frail’ by ICE and ‘fit’ or ‘unfit’ from thorough review of the medical notes. Subjective data were compared against the more objective validated assessment of post-operative outcomes using established CPET ‘cut-off’ metrics incorporating peak pulmonary oxygen uptake ( V̇O 2PEAK), V̇O 2 at the anaerobic threshold ( V̇O 2-AT) and ventilatory equivalent for carbon dioxide that collectively informed risk stratification. These data were retrospectively extracted from a single-centre prospective National Health Service database. Data were analysed using the Chi-square automatic interaction detection decision tree method. Results: A total of 127 patients examined that comprised 58 % male and 42 % female patients aged 69 ± 10 y with a BMI of 29 ± 7 kg/m 2. Patients were poorly conditioned with a peak pulmonary oxygen uptake almost 20 % lower than that predicted for age, sex-matched healthy controls with 35 % exhibiting a V̇O 2-AT <11 mL/kg/min. Disagreement existed between the subjective assessments of risk with ~34 % of patients classified not frail on ICE were considered unfit by notes review ( P < 0.0001). Furthermore, ~35 % of patients considered not frail on ICE and ~31 % of patients considered fit by notes review exhibited a V̇O 2-AT <11 mL/kg/min and of these, ~28 % and ~19 % were classified as intermediate-to-high risk. Conclusions: These findings highlight the interpretive limitations associated with the subjective assessment of patient frailty with surgical risk classification underestimated in up to a third of patients compared to the validated assessment of CRF. They reinforce the benefits of a more objective and integrated approach offered by CPET that may help improve perioperative risk assessment and better direct critical care provision in patients scheduled for ‘high-stakes’ surgery including open TAAA repair.

A 35-week neonate with esophageal atresia, tracheoesophageal fistula and tracheomalacia of was taken to a complex repair using bronchoscopic guidance. Invasive monitors were employed considering the length procedure and postoperative needs. Ventilation settings varied to maintain an adequate ventilation and surgical field. He was soon extubated in the ICU.

Natural hybrid zones provide opportunities for studies of the evolution of reproductive isolation in wild populations. Although recent investigations have found that the formation of neo-sex chromosomes is associated with reproductive isolation, the mechanisms remain unclear in most cases. Here, we assess the contemporary structure of gene flow in the contact zone between largely allopatric cytotypes of the dioecious plant Rumex hastatulus, a species with evidence of sex chromosome turn-over. Males to the west of the Mississippi river, USA, have an X and a single Y chromosome, whereas populations to the east of the river have undergone a chromosomal rearrangement giving rise to a larger X and two Y chromosomes. Using reduced-representation sequencing, we provide evidence that hybrids form readily and survive multiple backcross generations in the field, demonstrating the potential for ongoing gene flow between the cytotypes. Cline analysis of each chromosome separately captured no signals of difference in cline shape between chromosomes. However, principal component regression revealed a significant increase in the contribution of individual SNPs to inter-cytotype differentiation on the neo-X chromosome, but no correlation with recombination rate. Cline analysis revealed that the only SNPs with significantly shallower clines than the genome-average were located on the neo-X. Our data are consistent with a role for neo-sex chromosomes in reproductive isolation between R. hastatulus cytotypes. Our investigation highlights the importance of studying plant hybrid zones in species with sex chromosomes for understanding mechanisms of reproductive isolation and the role of gene flow in the spread of neo-X chromosomes.

The Scutum of Bactrocera dorsalis individuals shows a high degree of variability in their colouration, which goes from black to brown. Such variation depicts a different level of melanin production in these individuals. Here we asked whether the progeny produced by four melanic morphs of B. dorsalis would present a difference in their developmental time, weight, wing size and shapes. To address this, we followed eggs produced by gravid females of each B. dorsalis melanic morphs by recording their pupation time, emergence time, and larval, pupal and adult weights. Also using the landmark-based geometric morphometric analysis we assessed the variation in wing size and shape of the adults obtained from each parental melanic morphs of B. dorsalis. We found that larvae produced by adults with dark scutum exhibited faster development and weighed more than those produced by adults with brown scutum. At adult stages, individuals from parents with darker and brown scutum had a reduced weight and wing size (length, width, area and centroid size) as compared to those from the parents with moderate melanin production. We also found a significant wing shape variation across the four melanic morphs. Our study shows that melanisation in the scutum of B. dorsalis has a fitness gain in the preimaginal stages of this fly. While in the adult stage, the heavier or the lesser melanin production in the scutum has a fitness cost. This suggests that there is a trade-off between melanin production and other fitness parameters in B. dorsalis which could have implication on its flight and dispersal and consequently, its management.

Pityriasis rosea is a common, acute, self limiting inflammatory skin disease. Pityriasis rosea-like eruptions (PR-LE) have been reported after drugs. The clinical presentation of PR-LE can be distinguished from pityriasis rosea. We reporte a 41-year-old woman who developed PR-LE 5 days after administration domperidone.

Multiple sclerosis is a disease that affects the central nervous system, resulting in a variety of symptoms such as vision , physical activity and stability .Central positional vertigo as an initial multiple sclerosis symptoms is a rare case in the literature.

We present an 8-year-old with absence, generalize tonic-clonic and myotonic-atonic seizures who was diagnosed with Doose syndrome based on clinical presentation and EEG findings. A genetic panel found a SUOX gene mutation which has not yet been correlated with Doose syndrome. Her presentation does not resemble known SUOX related disorders.

Sex reversal, a mismatch between phenotypic and genetic sex, can be induced by chemical and thermal insults in ectotherms. Therefore, climate change and environmental pollution may increase sex-reversal frequency in wild populations, with wide-ranging implications for sex ratios, population dynamics, and the evolution of sex determination. We propose that reconsidering the half-century old theory "Witschi's rule" should facilitate understanding the differences between species in sex-reversal propensity and thereby predicting their vulnerability to anthropogenic environmental change. The idea is that sex reversal should be asymmetrical: more likely to occur in the homogametic sex, because sex-reversed heterogametic individuals would produce new genotypes with reduced fitness. A review of the existing evidence shows that while sex reversal can be induced in both homogametic and heterogametic individuals, the latter seem to require stronger stimuli in several cases. We provide guidelines for future studies on sex reversal to facilitate data comparability and reliability.

CASE REPORT Double purse-string suture surgical wound closure after excision of nipple adenoma of the breast: a case report. Kanelina Bimpa1, Theodosia Charitou1, Apostolos C. Ziogas2, Konstantinos Kantounis3, Emmanouil Xydias4, Mattheos Bobos5,6, Elias Tsakos1 1Department of Breast Surgery, Embryoclinic, IVF Unit, Thessaloniki, Greece2University of Thessaly, School of Health Sciences, Department of Medicine 3Department of Dermatology, Private Clinic, Thessaloniki, Greece.4University of Thessaly, School of Health Sciences, Department of Medicine 5Department of Biomedical Sciences, School of Health Sciences, International Hellenic University, Alexandrian Campus, Thessaloniki, Greece.6 Μicrodiagnostics Ltd Pathology Lab, Thessaloniki, Greece.  Correspondence to: Apostolos C. Ziogas, University of Thessaly, School of Health Sciences, Department of Medicine Rousvelt Street, 2441222Larissa, Greece+30 241 400 8018ziogasapo@hotmail.com  Declarations of interest: none Abstract: We present a rare case of nipple adenoma in a 53-year-old Caucasian woman. The lesion presented with a hemorrhagic nipple surface and was treated with wide surgical excision of the nipple and part of the surrounding areola and with a double purse-string surgical closure of the remaining areolar area. This technique was considered safe and effective and aimed to reconstruct the nipple area, thus providing the patient with an acceptable aesthetic result. Double purse-string surgical closure is proposed as a unique and straightforward, oncologically safe surgical procedure. This technique combines complete removal of the nipple adenoma, preservation of the remaining areola, minimization of skin flattening at the reconstructed area, improvement of the long-term aesthetic result and provision of a satisfactory surgical option for the patient.  Keywords: Breast, Nipple, Nipple adenoma, Nipple and Areaola reconstruction, Case report Key clinical message: Nipple adenoma is a rare, benign pathology that requires adequate excision and satisfactory surgical reconstruction. Our excision and double purse-string suture method covered both requirements, forgoing necessitation of special training of the surgeon or expensive equipment, thus rendering it a simple, safe and effective treatment option.  Introduction Nipple Adenoma (NA), also referred to as erosive adenoma or florid papillomatosis of the breast [1], is a rare benign breast disease affecting the nipple; it is considered a generally under-recognized condition and it usually affects middle-aged women with an average age of 43-45 years [2]. Exact incidence rate is not yet known due to its rarity, however certain studies estimated that the pathology was present in one out of every 8,000-8,500 skin biopsies or surgical specimens [3], implying a greater incidence in the general population. Male and adolescent patients have been reported, however they are the exception, accounting for under 5% of recorded cases [3].  NA presents clinically with nipple enlargement, nipple discharge (serous or hematic) and the presence of palpable lesion or erosion of the nipple [4, 5], with other clinical manifestations including benign developmental variations, inversion, retraction, or enlargement of the nipple, which may be of either benign or malignant nature, skin changes in and around the nipple, infections with resultant nipple changes or the presence of subareolar mass [6].  Several diagnostic and other examination tools are being used to assess NA, including mammography, breast ultrasonography, galactography, magnetic resonance imaging, cytology examination and core biopsy and histo-pathology examination [3]. Accurate clinical evaluation and management of NA usually requires a multi-disciplinary approach, involving primary care physicians, dermatologists, breast specialists and histopathologists [7]. This thorough diagnostic approach is necessary, as NA may clinically mimic malignant conditions such as Paget’s disease, carcinoma of the breast or nipple eczema [8] and adequate histological assessment is vital in the differentiation of the pseudo invasive pattern that often characterizes NA, a benign tumor, from breast cancer precursors and aggressive carcinoma [9-11]. Treatment of NA is surgical, with various techniques having been described, however no single approach has, yet, been proposed as the gold standard. This report presents the case of NA in the nipple areolar complex (NAC) area treated with the Double Purse-String (DPS) technique, a novel surgical excision and reconstruction method. The following case is presented in accordance with the CARE reporting checklist. Case Presentation  A Caucasian woman, aged 53, presented to the breast surgery department with a small nodule on her left nipple, self-diagnosed 6 months prior to her visit. The patient reported that the nodule had slightly increased in size, had formed a traumatic surface and that a mildly hemorrhagic discharge was produced. The patient had a negative personal and family history for cancer, no breast cancer risk factors, no other comorbidities or administered medications. She did not recall any trauma on her left breast and reported no other symptoms, such as pruritus of the area. Upon physical examination the nodule was soft, fragile and bled easily. Physical examination, ultrasound scan and mammography of the breasts were negative for any associated pathology. Cytology examination of the nipple discharge was negative for cancerous cells and scanty presence of red cells was reported. The hypothesis of NA was proposed and the patient was referred to a dermatologist, who performed a punch biopsy in order to confirm the diagnosis. Histopathology examination revealed benign nodular glandular proliferation on the nipple area embedded in a fibrotic stroma. Immunohistochemical evaluation using the p63 / h-caldesmon cocktail, revealed the presence of myo-epithelial cells. Cytokeratin 5/6 identified features of usual ductal hyperplasia, whereas the estrogen receptor expression was low. The diagnosis of nipple adenoma was confirmed with the typical histological and immunohistochemical features. The excision of the lesion confirmed the initial biopsy diagnosis (Figure 1).  The patient underwent surgical excision of the nipple adenoma under local anesthesia. Prior to the procedure, the patient was marked twice pre-operatively, with two concentric circles around the areola region (Figure 2), the distance between the two aiming to be similar to the protrusion of the right nipple. After the complete excision of the nipple, which was completely covered by the adenoma, two purse string sutures were placed at the remaining areola; one at the edge of the incision (inner marked circle), and one at the periphery (outer marked circle), at a suitable distance so as to allow for adequate projection of the areola skin, thus mimicking the contra-lateral nipple. A coated vicryl 910 4.0 thread was used, due to its slow absorption and its being braided, thus more likely to hold its position and maintain the projection for longer. Tightening of the two sutures was applied with caution in order to avoid any tension during healing process. (Figure 2). The patient fully recovered with no complications and was discharged one hour after the procedure. A comprehensive, step-by-step description of the DPS technique has been illustrated in detail (Figure 3).  The patient was examined at 10 days and 4 months post-operatively and underwent follow-up assessment every 6 months. There was minimal flattening of the area but enough projection to mimic a nipple. The patient reported satisfactory aesthetic result and had no intention of further aesthetic interventions. There were no adverse and/or unanticipated events observed. The patient signed an informed consent form according to the institutional regulations for this publication. Discussion Several surgical approaches and reconstruction options post NA excision have been proposed in the available literature. Such techniques are purse-string for nipple adenoma, nipple elevation and nipple-areola reconstruction [7, 12-14], in which NAC creation is the last step in the breast reconstruction process and is vital as it greatly affects patients psychologically. The main challenge is to maintain the projection of the reconstructed nipple over time when the original was removed. Local graft reconstruction combined with tattooing is the most popular technique, with individualized treatment options accounting for patient anatomical characteristics and aesthetic preferences, with results unfortunately not always proving satisfactory. To avoid this challenging reconstruction step, other, more conservative methods have also been proposed. Lee et al[15] utilized Moh’s Micrographic Surgery (MMS) and proposed that, if applied early, it could facilitate the excision of the tumor with the preservation of the nipple. Similarly, Bae et al [16] performed cryosurgery in their patient, a technique that is gaining ground as a minimally invasive treatment of NA as well, with remarkable outcomes as far as aesthetics are concerned. In this report, we presented a Double Purse-String (DPS) technique, which allows for the complete surgical excision of the nipple while preserving the surrounding relatively large areola using a DPS suture on the wound.  Subsequently the suture can be used to reshape the areola, create a skin projection (reconstructed nipple), adjust the size, avoid tension, prevent flattening or dissatisfying defects and offer adequate projection; thus adapting to the morphology of the contralateral healthy nipple and preserving breast symmetry. Additionally, patients maintain sensation  in the reconstructed area, which promotes an overall feeling of post-operative satisfaction and offers psychological  benefits, with complementary options, such as 3D tattooing of the areola  following recovery being available as well. To our knowledge this is the first case of the DPS technique being used in the treatment of NA. The main strength of our proposed method is that a symmetric nipple-areola complex was created that matched the contralateral nipple in size, color, position and projection, giving it a pleasing and natural appearance. It achieved a sustained projection of the areola without complications, such as irregularities and hypertrophic scar. Another advantage is that the DPS technique can be performed in cases of larger or even aggressive NA as well, since surgical reconstruction only requires a small remnant of the surrounding areola, thus facilitating the removal of larger tumors. In contrast, other, less invasive techniques can only be applied in benign and localized lesions, since no reconstruction is performed. Such techniques also require specialized training and expertise on the part of the surgeon in order to be effectively performed, whereas our proposed DPS method is significantly simpler and requires minimal additional training. This advantage of DPS is given even greater emphasis when the rarity of NA is considered, as more complex techniques require more cases to overcome the learning curve and attain expertise. The less invasive techniques also carry the admittedly low, but plausible risk of recurrence due to incomplete resection, a phenomenon observed by Perzin et al [17], who noted 7% recurrence rate in cases treated via local excision, as well as of malignancy arising from NA, a rare but documented occurrence in eight cases [3]. There are certain minor concerns regarding the DPS technique and its practical application that should be addressed. One such concern is the use of the particular suture thread, as it has been reported to increase propensity to infection and local tissue reaction. Since this is a single case, no other sutures have been tested for more favorable results, however, it is our belief that with proper management pre-, intra- and post-operatively, the possibility of future nipple flattening can be minimized, as we observed in the reported case. Another is the fact that for an aesthetically satisfactory result, adequate residual areola area is necessary to achieve sufficient projection and an overall appearance similar to the contra-lateral nipple, thus it would be more sensible to utilize the DPS technique in cases with adequate residual NAC size post-excision for optimal aesthetic results. Additionally, breastfeeding mothers might face difficulties due to the architectural distortion of the nipple and underlying ducts area, however no evidence-based conclusions can be reported yet, as our patient was post-menopausal. Besides, most cases of NA arise in 43 to 45-year-old, women, who have very likely already completed childbearing.  In our point of view, treatment of NA by the DPS technique is an effective therapeutic intervention, not only due to the assured complete resection of the tumor, but also because of the aesthetically pleasing result that can be achieved; a result comparable to the more advanced, less invasive surgical techniques, though without the higher risk for post-operational residual tumor that these techniques confer.  ConsentWritten informed consent was obtained from the patient for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Footnote:Reporting Checklist: The authors have completed the CARE reporting checklist. Conflicts of InterestThe authors have no conflicts of interest to declare. AcknowledgementsThe authors kindly thank Anna Ntanika (University of Ioannina, Faculty of Medicine) for her contribution of the featured medical illustrations. Ethical StatementThe authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee(s) and with the Helsinki Declaration (as revised in 2013). Written informed consent was obtained from the patient. Author contributions:1)         Kanelina Bimpa: conception and design, administrative support, provision of study materials or patients, collection and assembly of data, data analysis and interpretation, manuscript writing, final approval of manuscript2)         Theodosia Charitou: conception and design, provision of study materials or patients, collection and assembly of data, manuscript writing, final approval of manuscript3)         Apostolos C. Ziogas: collection and assembly of data, data analysis and interpretation, manuscript writing, final approval of manuscript, manuscript submission4)         Konstantinos Kantounis: conception and design, administrative support, provision of study materials or patients, collection and assembly of data, final approval of manuscript5)         Emmanouil Xydias: collection and assembly of data, data analysis and interpretation, manuscript writing, final approval of manuscript6)         Mattheos Bobos: conception and design, provision of study materials or patients, collection and assembly of data, manuscript writing, final approval of manuscript7)         Elias Tsakos: administrative support, provision of study materials or patients, collection and assembly of data, data analysis and interpretation, final approval of manuscript References [1] Abdulwaasey M, Tariq MU, Minhas K, Kayani N. Invasive Breast Carcinoma Arising in a Nipple Adenoma After 15 Years: Report of a Rare Case and Literature Review. Cureus. 2020;12(6):e8586. DOI: 10.7759/cureus.8586[2] Handley RS, Thackray AC. Adenoma of nipple. Br J Cancer. 1962;16(2):187-94. DOI: 10.1038/bjc.1962.21[3] Salemis NS. Florid papillomatosis of the nipple: a rare presentation and review of the literature. Breast Dis. 2015;35(2):153-6. DOI: 10.3233/bd-150397[4] Brownstein MH, Phelps RG, Magnin PH. Papillary adenoma of the nipple: analysis of fifteen new cases. J Am Acad Dermatol. 1985;12(4):707-15. DOI: 10.1016/s0190-9622(85)80155-9[5] Aftab K, Idrees R. Nipple adenoma of breast: a masquerader of malignancy. J Coll Physicians Surg Pak. 2010;20(7):472-4. DOI: [6] Bick U, Trimboli RM, Athanasiou A, Balleyguier C, Baltzer PAT, Bernathova M, et al. Image-guided breast biopsy and localisation: recommendations for information to women and referring physicians by the European Society of Breast Imaging. Insights Imaging. 2020;11(1):12. DOI: 10.1186/s13244-019-0803-x[7] Fujii T, Yajima R, Morita H, Yamaguchi S, Tsutsumi S, Asao T, et al. Adenoma of the nipple projecting out of the nipple: curative resection without excision of the nipple. World J Surg Oncol. 2014;12:91. DOI: 10.1186/1477-7819-12-91[8] Healy CE, Dijkstra B, Walsh M, Hill AD, Murphy J. Nipple adenoma: a differential diagnosis for Paget's disease. Breast J. 2003;9(4):325-6. DOI: 10.1046/j.1524-4741.2003.09417.x[9] Gudjónsdóttir A, Hägerstrand I, Ostberg G. Adenoma of the nipple with carcinomatous development. Acta Pathol Microbiol Scand A. 1971;79(6):676-80. DOI: 10.1111/j.1699-0463.1971.tb01870.x[10] Jones MW, Tavassoli FA. Coexistence of nipple duct adenoma and breast carcinoma: a clinicopathologic study of five cases and review of the literature. Mod Pathol. 1995;8(6):633-6. DOI: [11] DI Bonito M, Cantile M, Collina F, D'Aiuto M, Liguori G, R DEC, et al. Adenoma of the nipple: A clinicopathological report of 13 cases. Oncol Lett. 2014;7(6):1839-42. DOI: 10.3892/ol.2014.2000[12] Pagkalos VA, Ghali S, Hedén P. Nipple elevation using loupes magnification and a double-layer purse-string suture. Aesthetic Plast Surg. 2013;37(2):354-8. DOI: 10.1007/s00266-013-0086-4[13] Shestak KC, Nguyen TD. The double opposing periareola flap: a novel concept for nipple-areola reconstruction. Plast Reconstr Surg. 2007;119(2):473-80. DOI: 10.1097/01.prs.0000246382.40806.26[14] Nicholson BT, Harvey JA, Cohen MA. Nipple-areolar complex: normal anatomy and benign and malignant processes. Radiographics. 2009;29(2):509-23. DOI: 10.1148/rg.292085128[15] Lee HJ, Chung KY. Erosive adenomatosis of the nipple: Conservation of nipple by Mohs micrographic surgery. J Am Acad Dermatol. 2002;47(4):578-80. DOI: 10.1067/mjd.2002.122752[16] Bae KN, Shin K, Kim WI, Yang MY, Lee WK, Kim HS, et al. Cryosurgery as a Minimally Invasive Alternative Treatment for a Patient with Erosive Adenomatosis of the Nipple. Ann Dermatol. 2021;33(2):182-5. DOI: 10.5021/ad.2021.33.2.182[17] Perzin KH, Lattes R. Papillary adenoma of the nipple (florid papillomatosis, adenoma, adenomatosis). A clinicopathologic study. Cancer. 1972;29(4):996-1009. DOI: 10.1002/1097-0142(197204)29:4<996::aid-cncr2820290447>3.0.co;2-h           

Insecticide resistance provides both a pressing threat to the control of vector-borne diseases and insights into the remarkable capacity of natural populations to show rapid evolutionary responses. Malaria control remains heavily dependent on deployment of insecticides, primarily in long lasting insecticide treated nets (LLINs), but resistance in the major malaria vectors has increased over the last 15 years. Identifying genetic mechanisms causing high-level resistance in mosquitoes, which may almost entirely overcome pyrethroid efficacy, is crucial for the development and deployment of potentially resistance-breaking tools. Using the Anopheles gambiae 1000 genomes data we identified a very recent selective sweep in Ugandan mosquitoes which localized to a cluster of cytochrome P450 genes. Further interrogation revealed a haplotype involving a trio of mutations, a point mutation in Cyp6p4, an insertion of a partial Zanzibar transposable element (TE) and a duplication of the Cyp6aa1 gene. The mutations appear to have originated recently in An. gambiae from the Kenya-Uganda border region, with stepwise replacement of the double-mutant (Zanzibar TE and Cyp6p4-236M) with the triple-mutant haplotype (including Cyp6aa1 duplication), which has spread into the Democratic Republic of Congo and Tanzania. The triple-mutant haplotype is strongly associated with increased expression of genes able to metabolise pyrethroids; is strongly predictive of resistance to pyrethroids but importantly, appears less effective against LLINs co-treated with the synergist piperonyl butoxide (PBO). Frequencies of the triple-mutant haplotype remain spatially variable even within countries, suggesting an effective marker system to guide deployment decisions for limited supplies of PBO-pyrethroid co-treated LLINs across African countries.

Gene drives that skew sex ratios offer a new management tool to suppress or eradicate pest populations. Early models and empirical work suggest that these suppression drives can completely eradicate well-mixed populations, but models that incorporate stochasticity and space (i.e., drift, and founder events) often result in loss or failure of the drive. We developed a stochastic model to examine these processes in a simple 1-dimensional space. This simple space allows us to map the events and outcomes that emerged and examine how properties of the drive’s wave of invasion affect outcomes. Our simulations, across a biologically-realistic section of parameter space, suggest that drive failure might be a common outcome in spatially explicit, stochastic systems, and that properties of the drive wave appear to mediate outcomes. Surprisingly, the drives that would be considered fittest in an aspatial model were strongly associated with failure in the spatial setting. The fittest drives cause fast moving, narrow drive waves that have a high chance of being penetrated by founder events, leading to failure. Our results also show that high rates of dispersal reduce the chance of failure because drive waves get disproportionately wider as dispersal rates increase. Overall, wide, slow-moving drive waves were much less prone to failure. Our results point to the complexity inherent in using a genetic system to effect demographic outcomes and speak to a clear need for ecological and evolutionary modelling to inform the drive design process.

BackgroundThe positive psychology and neurodiversity movements both aim to promote and improve wellbeing through strengths-based approaches. However, little is known about how positive psychology can support the wellbeing of autistic people. The present used character strengths profiles and a humour-based positive psychology exercise as potential tools to improve the life satisfaction and mental health of autistic adults. To our knowledge, this is first study to use these methods as possible ways of improving the wellbeing of autistic adults in the community in the UK. MethodForty-seven autistic adults completed self-rated standardised questionnaires about their character strengths, life satisfaction, happiness and depressive symptoms. Additionally, 22 participants from this group completed the three funny things exercise for one week, and follow-up questionnaires about happiness and depressive symptoms. ResultsCharacter strengths most frequently reported by autistic adults were Honesty, Appreciation of Beauty and Excellence, Love of Learning, Fairness and Kindness. Higher levels of life satisfaction were associated with character strengths of Hope, Honesty, Gratitude, Forgiveness and Zest (Vitality). Participants reported fewer depressive symptoms and similar levels of happiness after completing the three funny things exercise. Conclusions The most frequent character strengths were consistent with autistic traits reported in the wider body of autism literature, such as intense interests and strong attention to detail. The present study provides, for the first time, evidence for strengths- and humour-based interventions that can effectively be used in a community setting to promote positive wellbeing outcomes in autistic adults.

Allergy: Letter to the Editor

Cultivation and naturalization of plants beyond their natural range can bring previously geographically isolated taxa together, thereby increasing the opportunity for hybridization and inter-specific gene flow, the outcomes of which are not predictable. These anthropogenic events therefore allow us to study how hybridization and inter-specific gene flow affect genetic and phenotypic diversity. Here, we explore the phenotypic and genomic effects of increased inter-specific gene flow following the re-introduction of the cultivated Mentha spicata (spearmint) into the ranges of the native mints M. longifolia and M. suaveolens. Using morphological analyses, we show that the cultivated M. spicata has altered trichome characters, which is likely a product of human imposed selection for a more palatable plant or a byproduct of selection on essential oil production. Using whole genome sequencing, we then show that there is extensive genetic admixture between the morphologically defined mint taxa that to some extent is mediated by the cultivated M. spicata. This has, at least partially, resulted in a breakdown of the species barriers. However, despite this breakdown, we find that genetic variants associated with the cultivated trichome morphology continue to segregate in cultivated, naturalized, and wild populations and we identify three genes that may function in the production of the characteristic aromatic oils of mints. Although hybridization can increase species richness by forming new hybrid taxa, we here show that unless reproductive barriers are strong it can also merge species into population/coalescent complexes over evolutionary time.

IntroductionThe overarching goal of this research is to build a series of models that predict how an online community shares, reacts to, and interprets the news, using a dataset harvested from the social networking site Reddit.  https://www.reddit.com I used Reddit because it has a publicly available API, and clearly structured data. On reddit, users form into communities called subreddits- these online communities were the focus of my study research.I divided this document into three sections based upon methods and technologies.Section 1 outlines how I  used web APIs to collect data and scripting languages to sterilize and model the data. Section 2 outlines my experiments with statistical natural language processing models (Statistical NLP) specifically sentiment analysis and latent dirchilet allocations.Section 3 outlines my neural language processing models (Neural NLP), including recurrent neural networks and deep learning.Throughout this body of work, I developed skills that prepared me to undertake broader questions, beginning with simple sentiment analysis (tying words to connotation scores) and progressing to using a mixture of deep and recurrent neural networks to tackle more open-ended questions.I conclude that Sentiment Analysis, Topic Modelling, and Word Embedding models do not have the representational capacity to model how people will interpret the news. On the other hand, recurrent neural networks and deep learning have representational capacity but require large datasets. A promising research direction for the future would be optimizing deep learning models for smaller data sets. My future interests in this body of work aim to inquire about the volume of data necessary to ensure the fidelity of the results. Harvesting the DataHarvesting data from Reddit using python is straightforward with their well-documented API, called PRAW:[https://praw.readthedocs.io/en/stable/getting\_started/quick\_start.html]. For documentation on how API calls work in general, you may consult the following: [https://tray.io/blog/how-do-apis-work].

Aims and objectives: The COVID-19 pandemic caused an increase in hospitalizations for frail older people and required healthcare professional to make difficult ethical and medical decisions regarding intensive care unit admission and treatment. This study investigates the experiences of healthcare professionals with the use of a decision support tool when discussing treatment limitations with older patients with COVID-19. Methods: A qualitative approach was chosen to obtain further in-depth information on the experiences of the healthcare professionals with the conversations about treatment limitation and on the contribution of a decision support tool for frail older adults with COVID-19. The framework method was used for the data analysis. Results: The following themes illustrate the analyzed concepts for the subject conversations about treatment limitation: careful consideration, the conversation is a part of the job, the burden of the conversation, scheduling conversation and acquiring skills to perform the conversation. The concepts of the theme AGE-ICU evaluation are included in the following themes: considered and comprehensible overview, confirmation of own assessment, every decision is context and person dependent, contributes to considered decision and tool not needed because of own expertise. Conclusion: A decision support tool for older patients with COVID-19 may help the healthcare professional to objectify the patients’ health status and functioning and discuss risk factors for adverse outcomes. Besides this, the tool helps to initiate the difficult conversation with the patient and their family. Finally, the AGE-ICU contributes to shared-decision making because it helps patients to understand the suggested decision and patients are more involved in the decision-making process.

Abstract:This paper's main objective is to develop and validate a framework prediction based on  the use of various classifiers that operate on merged attributes to obtain more effective crash predictions from classifiers' outcomes. In order to systematically classify the crash through feature selection techniques, a data-driven approach was adopted to investigate  the best potential classifier to predict the contributing factors and the number of injuries/fatalities per collision. To produce diversity in learning techniques, by using the following methods Bayes Network, Naïve Bayes, J48, and K-Nearest Neighbor (KNN) for the year of 2019 and the 100 intersections with the high-risk for collisions generated from the NYPD Collision data using the 2014-2019 dataset. The findings indicate the classifier's accuracy was highest for the Naïve Bayes with 81.59%, followed by the Bayes Network with an accuracy of 81.57%, and J48 resulted in an accuracy of 80.81%, and KNN performed the lowest accuracy of 80.20%. Overall, the methodology and outcomes offer new insights into crash detection and be a  useful method to improve intervention efforts relevant to safer transportation planning. The geospatial analysis was performed, providing insight into areas with a frequency of  different types of collisions that could establish a pattern based on reoccurring locations within the same area/zip code. The geospatial analysis indicates that boroughs of Brooklyn and Queens have the highest numbers of collisions. The research also analyzed the relationship between the number of collisions and the conditions of the pavement. The findings suggest that the condition of the pavement has an impact on the  number of crashes. The total number of accidents was 55,827 and 3,622 intersecting  with a poorly graded condition of pavement; 227 total fatalities and 127 intersecting  with a poorly rated condition of the pavement. Keywords:Bayes Network, Naïve Bayes, J48, KNN and Geospatial Analysis, High-Risk Intersections, and Crash prediction.Introduction At over 27,000 persons per square mile, New York has the highest population density of any major city in the United States [27]. In developing safer roadways, planners and engineers must understand that the city is very diverse in transportation modes. The risk defines a probability of multiple levels of damages from a transportation planning procedure, such as injury, fatalities, liability, and property damages; all these elements create roadway vulnerabilities. As part of the roadway safety plan, the probability of an outcome, and any potential severity of the outcome if it occurs. Collision prediction is a critical component of transportation planning; it plays a role in the decision-making process and funding allocation to certain areas. (FHWA Manual, 2010) About 1.4 million households own a car compared to 3.1 total households based on the census tract. According to New York City Economic Development Corporation's (NYCEDC) study from 2018, the information is derived from Metro System Ridership and 2011-2015 ACS Microdata; the following are the average percentage of the vehicle ownership borough base: Manhattan, 22 percent, Brooklyn 44 percent, Queens 62 percent, Bronx 40 percent, and Staten Island 83 percent. With diverse vehicle types and roadway characteristics, 27 percent of commuters' travel via truck, car, or van. (NYCEDC, 2018) As a safety plan, NYC has adopted Vision Zero to achieve zero fatality. Based on the 2014 Vision Zero Year 4 Report, over 250 people were killed, and 4,000 were seriously injured in traffic crashes. Compared to the June 2020 Vision Zero report, there was a decrease in the number of fatalities to a total of 220 [4].