Sex ratios affect population dynamics and individual fitness, and changing sex ratios can be indicative of shifts in sex-specific survival at different life stages. While climate- and landscape-change alter sex ratios of wild bird populations, long-term, landscape scale assessments of sex ratios are rare. Further, little work has been done to understand changes in sex ratios in avian communities. In this manuscript, we analyse long-term (1961-2015) data on five species of ducks across five broad climatic regions of the United States to estimate the effects of drought and long-term trends on the proportion of juvenile females captured at banding. As waterfowl have a 1:1 sex ratio at hatch, we interpret changes in sex ratios of captured juveniles as changes in sex-specific survival rates during early life. Seven of twelve species-region pairs exhibited evidence for long-term trends in the proportion of juvenile females at banding. The proportion of juvenile females at banding increased for duck populations in the western United States and typically declined for duck populations in the eastern United States. We only observed evidence for an effect of drought in two of the twelve species-region pairs, where the proportion of females declined during drought. As changes to North American landscapes and climate continue and intensify, we expect continued changes in sex-specific juvenile survival rates. More broadly, we encourage further research examining the mechanisms underlying long-term trends in juvenile sex ratios in avian communities.

Introduction A risk associated with cystic fibrosis newborn screening (CFNBS) is parental misunderstanding of genetic information generated by the over 6,600 positive screens reported annually in the US. CFNBS algorithms incorporating DNA analysis can generate genetic information that requires clinical interpretation and has significance for the newborn, parents, and other relatives. Engagement between CF care centers and trained genetic counseling providers, such as licensed and/or certified genetic counselors (GCs), is variable and limited in providing information to CFNBS positive (CFNBS+) families. Methods Using a modified Delphi process, a workgroup of CF experts developed recommendations for engagement of genetic counseling services in CF care centers where CFNBS+ diagnostic evaluations are performed. Statements were assessed over three rounds of surveys, one face-to-face meeting, and through public feedback. Results Seventeen statements achieved >80% consensus (range: 82-100%). The workgroup affirmed prior CFF policy statements recommending genetic counseling for parents of infants with CFNBS+. The remaining statements addressed infrastructure and logistics of genetic counseling services, including defining appropriate training for genetic counseling providers and counseling content, establishing a path to equal access to genetic counseling providers across CF care centers, and setting a standard for client-centered CFNBS genetic counseling that is respectful of diverse patient needs and autonomy. Conclusions Implementation of client-centered genetic counseling for CFNBS+ families in CF care centers by providers with expertise in both CF and genetic counseling will require efforts to further define core concepts, enhance education of providers, and develop opportunities for access via telemedicine.

Objective: To study the effect of a low (0.5g) or a standard (1g) tranexamic acid (TA) dose compared to placebo on clinical and biological endpoints in women experiencing postpartum hemorrhage (PPH) Design: TRACES trial is a double-blind, randomized, placebo-controlled, dose-ranging study Setting: 8 women hospitals in France. Population: Women experiencing PPH > 800 mL during caesarean section. Method: After informed consent, patients were randomized to receive either TA 0.5g (n=57), TA 1g (n=58), or a placebo (n=60). Data were collected at 8 time-points. Main outcome measures: Efficacy: additional blood loss after study drug, maternal morbidity, safety, biology: D-dimers, plasmin-antiplasmin complexes (PAP), simultaneous-generation-thrombin-plasmin-potential. Results: Compared to 1g dose, 0.5g TA was less effective to reduce additional blood loss (300 mL [95% confidence interval (95%CI) 68 to 630] vs 134 mL [95%CI50 to 419] (p=0.042)). Compared to placebo, 1g TA, but not 0.5g, inhibited hyperfibrinolysis as shown by plasmin generation potential, % increase in D-dimers from injection to 120 minutes (93% [95%CI 68 to 118] vs 58% [ 95%CI 32 to 84] (p=0.06) vs 38% [95%CI 13 to 63] (p=0.003) and % increase in PAP from injection to 30 minutes (56% [95%CI 25 to 87] vs 13% [ 95%CI 18 to 43] (p=0,051) vs -2% [95%CI -32 to 28] (p=0.009)). Conclusions: In this study, fibrinolysis inhibition was more sustained after the administration of 1g TA compared to 0.5g TA or a placebo. Further pharmacokinetic-pharmacodynamic modelling will be needed to determine the optimal TA dose to be administered in PPH. NCT 02797119

A document by Mayra Daniela Peña Guerrero. Click on the document to view its contents.

The feedback between soil carbon (C) and climate has the potential to decrease in magnitude over time due to the thermal acclimation of microbial respiration, while, whose strength is highly uncertain, partly because the response of microbial respiration is regulated by multiple environmental factors simultaneously rather than by temperature alone. Using a 9-year two-way factorial experiment involving warming and multilevel nitrogen enrichment treatments from an alpine grassland, we show that microbial respiration acclimates to warming only under nitrogen enrichment and that the strength of thermal acclimation increases as nitrogen enrichment. We identified two contrasting pathways—via an enhancement of acclimation by soil acidification and a weakening of acclimation by the inhibition of soil C availability and stimulation of soil C-degrading enzymes—with a net positive effect of nitrogen enrichment on microbial thermal acclimation. Our findings emphasize the importance of considering multiple environmental factors in shaping the strength of thermal acclimation.

Objective: Non-invasive respiratory support has reduced the need for mechanical ventilation and surfactant administration in very premature neonates. We sought to determine how the increased use of non-invasive ventilation and less surfactant instillation has impacted the development of bronchopulmonary dysplasia (BPD) and compared BPD outcome applying four currently used definitions. Study Design: This is a retrospective, single center cohort study of neonates born at less than 28 weeks gestation between 2010 and 2018. A respiratory practice change (less surfactant and more non-invasive ventilation) occurred in 2014 following participation in the SUPPORT trial. Therefore, patients were divided into 2 epochs to compare postnatal respiratory and clinical course and BPD outcomes across four currently relevant definitions (VON, NICHD, Canadian, NRN). Results: Clinical and demographic variables were similar between epochs. Despite significant differences in maternal and infant characteristics and clinical course, the incidence of BPD was not significantly different between the 2 epochs regardless of the BPD definition utilized. There was a wide range in the incidence of BPD depending on the definition used. Conclusions: Despite decreased use of invasive mechanical ventilation and surfactant administration between the two epochs, the incidence of BPD did not change and there was wide variation depending on the definition used. A better understanding of the risk factors associated with BPD and a consensus definition is urgently needed in order to facilitate the conduct of clinical trials and the development of novel therapeutic interventions to improve outcome.

Present study evaluated the fatty acid profile and oxidative stability of Shorea macrophylla and Shorea palembanica oils. Analysis on fatty acid profile of S. macrophylla and S. palembanica oils using gas chromatography mass spectrometer (GC-MS) and fourier transform infrared spectroscopy – attenuated total reflectance (FTIR-ATR) found no significant difference among the oils. Stearic, palmitic and oleic acids are the major fatty acids in Shorea oils. The influence of type of extraction, fatty acid profile, and anti-oxidant activity on acid value (AV) and peroxide value (PV) were determined using Pearson correlation coefficient (r) analysis. Highest correlation was found between type of extraction, antioxidant activity (phenolic content), AV and PV, suggesting the type of extraction strongly influenced the phenolic content and oxidative stability. S. macrophylla oil extracted using mechanical expeller (MESM) have the highest quality oil (AV: 3.76 mg NaOH/g; PV: 7.96 meq O2/kg) compared to SESM, MESP and SESP oils. Similarities in fatty acid composition and oxidative stability of Shorea oil and cocoa butter indicates the potential of Shorea oil to be utilised industrially as Cocoa Butter Equivalence (CBE) and vegetable oil. Shorea oilseeds contain an appreciable amount of essential macrominerals and a comparable amount of microminerals to common seeds. The anti-nutritive factor oxalate was found higher (p<0.05) in S. palembanica oilseeds than in S. macrophylla with values of 0.14 and 0.12 g/100 g respectively. The amount of phytate in Shorea seeds is not significantly different at 5% level with a value of 0.29 g/100 g.

If we knew many terms and phrases we commonly use such as, for example, sanity check, grandfathered, ladies and gentlemen or low man on the totem pole can discourage coworkers, colleagues, collaborators and other potential contributors from participating in our projects with their full authentic selves, would we still use them?

LETTER TO THE EDITOR

Supraclavicular Lymphadenopathy after COVID-19 vaccinationKelsey Larkin 1, Archana Sharma DO2, Richard Drachtman MD,2, Gratian Salaru , MD31 Robert Wood Johnson Medical School2Division of Pediatric Hematology, Rutgers Cancer Institute, Robert Wood Johnson Medical School3Department of Pathology, Robert Wood Johnson Medical SchoolCorrespondence to Archana Sharma, DO, Rutgers Cancer Institute of NJ, 195 Little Albany Street, Room 3507, New Brunswick, NJ 08901.Telephone: 732-235-8864Sharmaar@cinj.rutgers.eduText Word Count: 974Brief running title: Lymphadenopathy after COVID-19 vaccination.Key words: lymphadenopathy, COVID-19, vaccine,Images: 2

Objective Investigate the effect of an antenatal lifestyle education seminar on reducing preterm birth, and whether education timing modifies outcomes among women with different characteristics. Design Retrospective cohort study Setting A metropolitan hospital in Beijing, China Population A total of 3008 singleton livebirths Methods Extracted data from deidentified electronic medical records were analyzed. Odds ratios (ORs) for preterm birth according to antenatal education attendance using stepwise binary logistic regression stratified by different maternal characteristics was conducted. Outcome measure Preterm birth (gestational age <37+0 weeks) Results Overall prevalence of preterm birth was 8.7%, but higher for women who did not attend the antenatal seminar (11.5%). Risk of preterm birth for first trimester attendees decreased by 53% ([OR] 0.47, 95% CI 0.35-0.64), and 41% for later attendees ([OR] 0.59, 95% CI 0.41-0.86). Estimates persisted after adjusting pre-existing and gestational covariates. In subgroup analysis, young or nulliparous women who attended later than first trimester were at decreased risk. For women aged ≥35 years, multiparous, who had a previous caesarean section/myomectomy, the risk of preterm birth was reduced among first trimester attendees, but no longer significant after adjusting for pre-existing and gestational covariates (p > 0.05). Timing of the seminar was not significant for women received assisted reproductive technologies. Conclusions Offering an antenatal lifestyle education seminar was associated with lower preterm birth risk and was modified by education timing and women’s characteristics. Results can inform the development of tailored preterm birth prevention strategies. Keywords Antenatal education, lifestyle factors, preterm birth, intervention timing, health promotion.

Antineutrophil cytoplasmic autoantibodies associated vasculitis(AAV) is characterized by antibodies against antigens in cytoplasmic granules of neutrophils and predominantly affects small vessels. AAV after COVID-19 mRNA vaccination has been reported. We report rare case of AAV in a patient who presented with rapidly progressive glomerulonephritis(RPGN) after Johnson & Johnson vaccine administration.

Unroofed Coronary Sinus (UCS) is an uncommon congenital heart anomaly and the most unusual type of Atrial Septal Defect.This report presents a-71-year-old female with palpitation and dyspnea following an emotional stress, who was referred for ablation of typical atrial flutter.Finally diagnosed with a partially UCS causing a bidirectional shunt.

Foot-and-Mouth Disease (FMD) is one of the most important animal diseases hindering livestock production in Thailand. In this study, a temporal and spatial analysis at the subdistrict level was performed on FMD outbreak reports in Thailand from 2011 to 2018. Risk factors associated with FMD outbreaks were investigated using generalised estimating equations. The results showed that the incidence of FMD outbreaks was the highest in 2016 and was affected by season, with a peak in FMD outbreaks occurring in the rainy-winter season. The occurrences of FMD were mostly distributed as a number of small clusters within a few subdistricts. Some high-risk areas with repetitive outbreaks were detected in the central regions. Risk factors significantly associated with FMD outbreaks included the size of the dairy, beef, and pig populations in each subdistrict, the distance to the nearest subdistrict with an outbreak, the percentage of forest area, international border contact, the presence of a livestock market, and the occurrence of an FMD outbreak in a neighbouring subdistrict in the previous month. This study helped to identify high-risk areas and periods of FMD outbreaks in Thailand. Together with the identified risk factors, its results can be used to optimise the FMD control program in Thailand and in other countries having a similar livestock industry and FMD situation.

The risk of extrapulmonary tuberculosis increases in patients with human immunodeficiency virus (HIV) infections. Encephalitis is a rare form of extrapulmonary tuberculosis infection. We report a case of encephalitis associated with cervical lymph nodes tuberculosis in a patient with human immunodeficiency virus (HIV) infections.

Structures, stabilities, and interactions of AuX (X = C - Pb) series are theoretically investigated at CCSD(T) and B3LYP levels with extend basis sets. Natural bond orbital analysis shows that the Au-X interaction is resulted by the overlap of sp hybrid on X and 6s5d hybrid on Au atom. Laplacian and total electronic energy density values at BCP shows the “intermediate type” of Au-X (X = Si, Ge, Sn, Pb) interactions and covalent type of Au-C interaction. Moreover, analysis of electron density deformation shows pronounced charge accumulation in the middle of the region between lighter X and Au, suggesting obvious covalent character of interaction. ELF shows increased covalency from X = Pb to X = C. Energy decomposition analysis shows positive steric contribution and negative quantum contributions to the Au-X interactions. Comparing the interaction energy of AuC with other AuX series, the decrease of interaction strength between them is caused by the positive contribution of steric effect and the negative contribution of quantum and electrostatic effects. Steric charge distribution shows interaction type causes effects to distribution of steric charge. And steric energy is correlated positively with the total interaction energy and correlated positively with the steric charge deformation at BCP.

Acalvaria is a rare and lethal congenital malformation characterized by the absence of the cranial vault bones, dura mater and associated muscles with complete cranial content. We report a 5-year-old Malian girl seen at 20 months old for facial dysmorphia, hemiparesis, and a cranial bone defect that improved progressively.

Background: Persistence or recurrence of stenosis is a complication of initial coarctation repair. This study aims to report short-term outcomes of surgical management of recurrent coarctation and initial repair analysis. Methods: We retrospectively reviewed our experience with 51 patients undergoing recoarctation surgical repair between 2008 and 2019 using antegrade cerebral perfusion technique. Results: Surgical correction included prosthetic patch aortoplasty in 23 (45%), resection with wide end-to-end anastomosis in 15 (29%) and a tube interposition graft in 13 (25%) patients. Median age at initial correction and reintervention were 12 month and 9 years. Median interval from primary repair to reintervention was 60 months. Initial repair analysis revealed 33% of patients had initial correction in the neonatal period, 72,5% of patients were done via a left thoracotomy approach and 63% of patients had end-to-end anastomosis at initial surgery. Conclusion: Our study demonstrates that surgical repair of recurrent coarctation of the aorta using antegrade cerebral perfusion technique can be performed safely and with excellent results.

Compounds with (NHC)→E coordination bond are being generated and their chemistry is being explored over the past 15 years (NHC= N-heterocyclic carbenes, E = main group elements). Many examples of species with N-heterocyclic olefins (NHOs) are known, which exhibit umpolung chemistry. Increasing number of chemical species, which carry NHC as a functional unit, are being reported. There is a need to understand their electronic structure. Alkylated imidazole oximes (cationic, found useful in medicinal chemistry) ((NHC)-C(H)=N-OH(+)) carry NHC unit as a functional group. Similarly, the corresponding nitroso-N-heterocyclic olefins ((NHC)=C(R)-N=O) also carry NHC as a functional unit. It is important to establish the interaction between the NHC unit and the rest part of the molecule in these species. Density functional (DFT) study has been carried out to explore the electronic structure details of a few oximes and nitroso NHOs. The results indicate that a structure with NHC→C coordination interaction can be considered as one of the resonance structures of these species.

Introduction: Temporal trends in CF survival from low-middle-income settings are poorly reported. We describe changes in CF survival after diagnosis over 40 years from a South African (SA) CF center. Methods: An observational cohort study of people diagnosed with CF from 1974 to 2019. Changes in age-specific mortality rates from the year 2000 (versus before 2000) were estimated using multivariable Poisson regression. Data were stratified by current age < or ≥ 10 years and models controlled for diagnosis age, sex, ethnicity, genotype, and P. aeruginosa (PA) infection. A second analysis explored association of mortality with weight and FEV1z-scores at age 5-8 years. Results: 288 people (52% male; 57% Caucasian; 44% p.Phe508del homozygous) were included (median diagnosis age 0.5 years: Q1,Q3: 0.2, 2.5); 58 (35%) died and 30 (10%) lost to follow-up. Among age >10 years, age-specific mortality from year 2000 was significantly lower (adjusted hazard ratio aHR: 0.14; 95% CI: 0.06,0.29; p<0.001), but not among age <10 years (aHR: 0.67; 95% CI: 0.28,1.64; p=0.383). In children <10 years, Caucasian ethnicity was associated with lower mortality (aHR 0.17; 95% CI 0.05,0.63), and time since first PA infection with higher mortality (aHR 1.31; 95% CI 1.01,1.68). Mortality was 7-fold higher if FEV1z was < -2.0 at age 5-8 years (aHR 7.64; 95% CI 2.58,22.59). Conclusion: Overall, CF survival has significantly improved in SA from year 2000 in people older than 10 years. However, increased risk of mortality persists in young non-Caucasian children, and with FEV1z<-2.0 at age 5-8 years.

Although the incidence of hematological toxicity due to FTD/TPI treatment is high, the incidence of severe adverse events has been reported to be relatively low. However, it should be noted that patients with renal impairment are prone to severe hematological adverse events.

The bonding evolution theory has been used to investigate the flow of electron density along the reaction pathways of ethyl acetate 2-oxo-2-(4-oxo-4H-pyrido [1.2-a] pyrimidin-3-yl) polyazaheterocycle (1) and ethylenediamine (2). This reaction has three channels (1-3) and each one takes place via three or four steps. DFT results reveal that channel 2, which goes through imine intermediate is by far the most favorable one, and the main product 3 is more stable than 4 and 5, showing that this reaction is under kinetic and thermodynamic control, in clear agreement with the experimental outcomes. The BET analysis allows identifying unambiguously the main chemical events happening along channel 2. For this reaction channel, the mechanism along the first step (TS2-a) is described by a series of four structural stability domains (SSDs), while five SSDs are required for the second (TS2-b) and the third (TS2-c) one. The first step can be summarized as follow, the appearance of V(N1,C6) basin illustrating the formation of N1-C6 bond (SSD-II), the splitting of N1-H1 bond, followed by the restoration of the nitrogen N1 lone pair (SSD-III), and finally, the formation of the last O1-H1 bond (SSD-IV). For the second step, the formation of hydroxide ion is noted, consequent of the disappearance of V(C6,O7) basin, the transformation of C6-N1 single bond into double one (SSD-IV). Finally, the appearance of V(O7,H2) basin leading to the elimination of water molecule within the last domain. Overall, for the three reaction steps, the formation of the N-C bond appears always before the O-H one.

Background: Mycophenolate mofetil (MMF) is the most widely used second-line agent in auto-immune hepatitis (AIH). It is generally titrated up to patient response and continued for at least two years following complete liver enzyme normalization. However, in this maintenance phase individual dose adjustment to reach mycophenolic acid (MPA) exposure with the best benefit-risk probability may avoid adverse outcomes. The aim of the present study was to develop population pharmacokinetic (popPK) models and Maximum A-Posteriori Bayesian estimators (MAP-BEs) to estimate MPA inter-dose area under the curve (AUC0-12h) in AIH patients administered MMF using nonlinear mixed effect modelling. Methods: We analysed 50 MPA PK profiles from 34 different patients, together with some demographic, clinical, and laboratory test data. The median number of samples per profile, immediately preceding and following the morning MMF dose, was 7 [4 – 10]. PopPK modeling was performed using parametric, top-down, nonlinear mixed effect modelling with NONMEM 7.3. MAP-BEs were developed based on the the best popPK model and the best limited sampling strategy (LSS) selected among several. Results: The pharmacokinetic data were best described by a 2-compartment model, Erlang distribution to describe the absorption phase, and a proportional error. The best MAP-BE relied on the LSS at 0.33, 1 and 3 hours after mycophenolate mofetil dose administration and was very accurate (bias=5.6%) and precise (RMSE<20%). Conclusion: The precise and accurate Bayesian estimator developed in this study for AIH patients on MMF can be used to improve the therapeutic management of these patients.

In this study, high-speed ballistic impact tests were conducted on GH4169 alloy samples with the aeroengine compressor blade leading edge feature to simulate the notch-type foreign object damages (FOD). Macroscopic and microscopic characterization of FOD and high cycle fatigue tests were performed to investigate the effect of FOD depth on GH4169 alloy fatigue strength along with numerical analysis using Kitagawa-Takahashi diagram. Results show the incident side of notch-type FOD is relatively smooth, whereas the exit side is rugged. The FOD depth ranges from 0.18mm to 1.33mm, and the fatigue strength of damaged samples is 37.93%~97.04% of the undamaged samples. As FOD depth increases, damage length, material losses and stress concentration coefficient of the FOD increase significantly along with the increasing adiabatic shear bands, micro voids and cracks, resulting in fatigue strength reduction. Numerical analysis indicates that the Kitagawa-Takahashi diagram can provide a basic model for the design of FOD tolerance.